Mesothelioma Remission and Recurrence

What Is Mesothelioma Remission?

Mesothelioma remission means the cancer tumors have decreased in size by at least half or more. It marks a major, positive turn in your overall health. It may mean you can reduce or temporarily stop treatment. Some patients may be able to go on some form of maintenance therapy.

Remission can bring considerable emotional and physical relief after aggressive treatments. It can also inspire real hope for patients and their families.

The reality is that while mesothelioma can go into remission, recurrence often follows. Second-line treatments have shown to control mesothelioma recurrence.

Mesothelioma survivors can live for several years in partial remission, despite tumor activity. It’s something doctors must watch. For the patient, it means you can treat the disease as a chronic but manageable condition. 

Anecdotal evidence shows few survivors have lived 10-15 years or more without recurrence. This usually stems from an early diagnosis and an aggressive treatment approach.

Treatment’s Role in Mesothelioma Remission

Surgery is the treatment that will most likely lead to prolonged remission. It can also improve mesothelioma survival rate. Mesothelioma surgeries most likely to result in remission include the EPP and P/D.

Some patients have noted partial or complete remission with other anti-cancer treatments. These treatments include systemic chemotherapy, immunotherapy, targeted therapy and Tumor Treating Fields.

Patients also say dietary changes, nutritional supplements and oxygen therapy helped their remission.

It is possible to recover from aggressive treatment for mesothelioma and enter remission. Some survivors have remained in remission and extended their life expectancy with mesothelioma by three to 10 years or more. About 10% of all people diagnosed with mesothelioma live longer than five years. 

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Extrapleural Pneumonectomy (EPP) Surgery

EPP is an extensive procedure intended to remove all visible tumors from the body. It extracts the affected lung and everything else at risk such as the linings around the lungs and heart. The procedure also removes the diaphragm, which is later rebuilt with prosthetic material.

Chemotherapy and radiation are often used to kill remaining cancer cells. Despite those efforts, recurrence generally happens at some point.

A 2020 Japanese study published in Oncology Letters reported most recurrences after an EPP develop three months after the procedure, compared to 20 months for another, less radical mesothelioma surgery known as pleurectomy and decortication.   

Pleurectomy/Decortication (P/D)

Pleurectomy and decortication removes the lining around the lung, chest wall, heart and diaphragm. The lining around the heart and diaphragm is usually reconstructed using mesh.

The procedure is easier to tolerate than an EPP because the lung is not removed. But it is still an extensive surgery.

A 2020 Japanese study published in The Annals of Thoracic Surgery covering a five-year period showed 63.3% of patients undergoing pleurectomy and decortication developed a recurrence an average of 19 months after surgery. 

Sometimes, we get stuck in the concept of having to cure cancer and don’t always understand that we can be good at controlling it. It’s much more likely to be able to control [mesothelioma], than being able to kill every last [cancer] cell. If you can do that, you can live a long time with it.

Dr. Robert Cameron

Thoracic Surgeon

What Is Mesothelioma Recurrence?

Mesothelioma recurrence is a return of cancer after treatment. It also happens after an extended period of remission. This is different from cancer progression, which happens when tumors grow or spread.

Despite remission, mesothelioma recurs for all patients who undergo treatment. This happens because removing or killing every cancer cell is impossible. The remaining cancer cells eventually form tumors again.

The proximity of tumors to vital organs makes it difficult to remove every cancer cell. Doctors try to delay recurrence and keep cancer cells under control for as long as possible.

How Does Mesothelioma Recurrence Occur?

Mesothelioma recurs when cancer cells survive after surgery or chemotherapy. The cancer then grows again over time. When it returns, doctors define it in three ways.

Clinical Trials for Recurrent Mesothelioma

Researchers in clinical trials test new treatments for patients with recurrent mesothelioma. These treatments include new chemo and immunotherapy drugs.

Other trials research experimental therapies such as gene therapy and photodynamic therapy.

Mesothelioma Survivors in Remission

Cindy Christopher received her peritoneal mesothelioma diagnosis in 2006. She underwent extensive cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) that same year.

“I was fortunate to find the right doctor and the right place to be. I asked questions. I did my homework,” Christopher said. “In a way, I was a guinea pig in a new protocol, and it worked. Not all cancer institutes are doing the same thing. I chose the best possible surgeon, and I told him definitively, I will be your best patient.” 

Doctors diagnosed Trina Reif with peritoneal mesothelioma in 2001. Reif said recovery was challenging, but she’s proud of how far she’s come.

“I said if I could make my 20-year mark, I’d be so thrilled,” Reif said. “Every birthday is a blessing. Every year the good Lord gives me, I’m going to take.”