ASCO Publishes New Pleural Mesothelioma Guideline

Treatment & Doctors
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Last year, the American Society of Clinical Oncology (ASCO) set a goal to develop up-to-date recommendations for how to treat pleural mesothelioma.

To accomplish this, ASCO gathered together a panel of 14 experts from various medical specialties. The expert panel reviewed 222 research studies to see which treatment strategies have the best results.

ASCO published their findings online Jan. 18 in the Journal of Clinical Oncology.

The guideline recommends only minor changes to the established treatment approach. At the same time, it calls for more clinical trials that test new treatment technologies.

It also calls attention to challenges in improving doctor-patient communication, expanding access to health care, and managing multiple chronic conditions.

Surgery, Chemotherapy and Radiation Still Standard

A combination of tumor-removing surgery, chemotherapy and radiation therapy remains ASCO’s recommended approach to helping patients live longer with pleural mesothelioma.

Doctors often refer to this strategy as multimodal therapy.

For patients not eligible for surgery, the guideline recommends chemotherapy or palliative treatment to ease symptoms.


Between the two main options for tumor-removing surgery, the guideline says pleurectomy and decortication should be the first choice. The more invasive extrapleural pneumonectomy (EPP) carries higher risks for patients.

The guideline warns against major surgery for patients whose cancer has spread into both sides of the chest or the lymph nodes of the neck.

Surgery is also not recommended for patients with the sarcomatoid cancer cell type.


The guideline suggests adding bevacizumab (Avastin) to the standard chemotherapy drug combination, as long as there is no risk of dangerous side effects for the patient.

Radiation Therapy

The guideline advises radiation therapy should only be performed by experienced mesothelioma specialists at a top treatment center.

Need for More Clinical Trials

ASCO’s expert panel acknowledges many exciting advances in cancer treatment technology in recent years.

Despite this, the U.S. Food and Drug Administration has not approved a new first-line treatment for mesothelioma since 2004.

The guideline explains there simply is not enough clinical trial data yet to recommend a new treatment such as immunotherapy. Conducting large clinical trials has been challenging because mesothelioma is so rare.

The guideline encourages hospitals around the world to work together to enroll more patients in clinical trials. Doctors must tell pleural mesothelioma patients about the value of participating.

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Improving Communication with Patients

The guideline highlights two other issues in doctor-patient communication.

First, each scientific breakthrough improves cancer treatment but also adds more complicated medical vocabulary.

Physicians and patient advocates must make the effort to explain medical terms to patients in plain language. Patients cannot make informed decisions if they do not understand their diagnosis and treatment options.

Second, medical professionals must tell patients what they need to hear, not what they want to hear.

This means being realistic about the prognosis of pleural mesothelioma. It also means being frank about the advantages and disadvantages of each treatment option.

Doctors must balance the need to give patients hope with the responsibility to protect patients from risky treatment strategies and financial toxicity.

Expanding Access to Cancer Care

The ASCO guideline also highlights how certain patients face obstacles to quality cancer treatment.

Pleural mesothelioma patients and caregivers must deal with expenses related to health care and lost income. Patients who live far away from big cities have the extra burden of traveling for treatment.

Special support programs can play a vital role by providing resources for cancer patients.

Cancer patients from minority backgrounds often have poor insurance coverage, according to the ASCO report. Minority patients in America also suffer higher rates of comorbidities, which are other illnesses patients have at the same time as cancer.

The most common comorbidities include high blood pressure and diabetes. These chronic conditions can be just as dangerous as cancer.

Addressing Multiple Chronic Conditions

As cancer treatment technology improves, there is hope one day doctors will be able to manage pleural mesothelioma as a chronic condition.

However, the guideline points out this will create a new set of challenges.

Researchers and doctors must design cancer treatment plans that will not make a patient’s existing chronic conditions worse.

Unfortunately, this is one area where large-scale clinical trial data may not be as useful. Clinical trials often exclude patients with multiple chronic conditions.

Doctors must also make sure cancer patients manage their chronic conditions properly. In addition, there is the possibility cancer treatment itself may give a patient a new chronic condition such as kidney disease.

Thanks to the dedication of the American Society of Clinical Oncology and other organizations, however, medical practices continue to improve every year.

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