Last modified: October 27, 2021
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 a patient has completed an aggressive treatment regimen to stop tumor growth. It can also inspire real hope for patients and their families.
The reality is that while mesothelioma can go into remission, recurrence often follows. Thankfully, second-line treatments have been shown to control mesothelioma recurrence.
- Partial Remission
Doctors usually measure partial remission as at least a 50% reduction in tumor size.
- Complete Remission
This medical term indicates that all evidence of measurable cancer has disappeared. It’s rare with mesothelioma and not fully understood, but it is possible.
Mesothelioma survivors can live for several years in partial remission despite the presence of tumor activity. It’s something doctors must monitor closely. For the patient, it means you can treat the disease as a chronic but manageable condition.
Anecdotal evidence shows a few mesothelioma survivors have lived 10 to 15 years or more without signs of recurrence. This usually stems from an early diagnosis and an aggressive treatment approach.
Treatment’s Role in Mesothelioma Remission
After reviewing case histories, doctors have identified several factors that may contribute to mesothelioma remission. Surgery is the treatment that will most likely lead to prolonged remission and a better mesothelioma survival rate.
Some patients have noted partial or complete remission with other anti-cancer treatments, including systemic chemotherapy, immunotherapy, targeted therapy and Tumor Treating Fields. Patients have also attributed remission to significant dietary changes, nutritional supplements and oxygen therapy.
Mesothelioma surgeries most likely to result in remission include the aggressive extrapleural pneumonectomy and the lung-sparing procedure known as pleurectomy and decortication. Surgery effectively puts a patient into remission by significantly reducing the amount and size of mesothelioma tumors.
It is possible to recover from aggressive treatment for mesothelioma and enter remission for a long period of time. 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.
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 around it that could be affected in the future, including the linings around the lungs and heart. It also removes the diaphragm, which is later rebuilt with prosthetic material.
Chemotherapy and radiation are often used to kill remaining cancer cells left in the body. 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. A 2010 Italian study covering a 20-year period showed that 93% of pleural mesothelioma patients who underwent an extrapleural pneumonectomy surgery later developed tumor recurrence.
Pleurectomy and decortication involves removing the lining around the lung, chest wall, heart and diaphragm. The lining around the heart and diaphragm is usually reconstructed using mesh. The lung is not removed, making the procedure easier to tolerate than an EPP, although it is still an extensive, major 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 CameronThoracic Surgeon
What Is Mesothelioma Recurrence?
Cancer recurrence is a return of cancer after treatment and after an extended period of remission. This is different from cancer progression, which happens when tumors grow or spread.
Mesothelioma recurs for all patients who undergo treatment, even after the most aggressive treatment options successfully put it into remission. This happens because it is nearly impossible to surgically remove or kill every mesothelioma cancer cell. The remaining cancer cells eventually form tumors again.
The proximity of these tumors to vital organs makes it difficult for surgeons to completely remove every cancer cell despite the most advanced medical technology. The goal is to improve mesothelioma prognosis by delaying recurrence and keeping the cancer cells under control for as long as possible.
How Does Mesothelioma Recurrence Occur?
Mesothelioma typically recurs when cancer cells survive after surgery or chemotherapy. The cancer then grows again over time. When it returns, doctors normally define it in three ways.
- Local Recurrence
Tumors return to the same spot or close to where they were originally found. This type of recurrence may be the easiest to control if tumors are small and able to be removed surgically.
- Regional Recurrence
Tumors grow in tissues or lymph nodes near the original cancer location. If the tumors are small and limited in number, this type of recurrence may also respond well to surgery. Chemotherapy, immunotherapy, radiation therapy and targeted therapies may be used to control regional recurrences.
- Distant Recurrence
Metastatic cancer has spread to tissues far from the location of the original cancer. Mesothelioma rarely spreads to distant parts of the body. Local and regional recurrence is more common. Distant recurrences may respond well to all therapies used to control regional recurrences, except for surgery.
Surgery combined with chemotherapy and radiation has shown to delay recurrence longer than other treatment plans. Immunotherapy and chemotherapy are the next most effective therapies to prolong recurrence.
Clinical Trials for Recurrent Mesothelioma
There are many clinical trials aimed at patients with recurrent mesothelioma. Talk to your doctor to see if you qualify for one of them. Researchers are often looking for patients in which to use new drugs or procedures not used in the patient’s original treatment plan.
Clinical trials are where the latest treatments are tested. New chemotherapy and immunotherapy drugs are available through clinical trials to patients with recurrent mesothelioma. Other experimental therapies, such as gene therapy and photodynamic therapy, are also being explored through clinical trials that often accept mesothelioma patients with recurring tumors.
Mesothelioma Survivors in Remission
Cindy Christopher of New York has been in remission for peritoneal mesothelioma for more than a decade after undergoing extensive cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) in 2006. Christopher, 65, continues to have regular checkups and hasn’t seen signs of cancer recurrence. She previously overcame bouts of thyroid and skin cancer. The former teacher and registered nurse has returned to work in the garden department at her local Home Depot.
At this point, it’s just a matter of buying some time. And buying time is good. I’ve been pretty darn lucky my whole life.David KnappAir Force veteran diagnosed with pleural mesothelioma in 2016
Walter Merth of Philadelphia attributes the remission of his pleural mesothelioma to the immunotherapy drug pembrolizumab (Keytruda), which he received at Penn Medicine Abramson Cancer Center. He had experienced recurrence of his mesothelioma less than six months after aggressive pleurectomy and decortication surgery.
Although the U.S. Food and Drug Administration has not yet approved Keytruda as a first-line treatment for mesothelioma, doctors have been using it successfully for certain types of lung cancer and other malignant disorders such as head and neck cancer, metastatic bladder cancer and other types of cancer. Merth received the drug under a special FDA Expanded Access program.
Air Force veteran David Knapp of California has been in partial remission since starting a pemetrexed (Alimta) clinical trial at the Stanford Cancer Institute. Knapp was first diagnosed with pleural mesothelioma and underwent a combination of surgery, radiation and chemotherapy.
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