Mesothelioma Treatment
Watch: Dr. David Sugarbaker, a pioneer of mesothelioma treatment, discusses the most effective strategies for treating the disease.
How Is Mesothelioma Treated?
The American Society of Clinical Oncology in 2018 published its updated mesothelioma treatment guidelines that doctors follow when treating patients diagnosed with mesothelioma.
ASCO recommends the following mesothelioma treatment options:
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SurgeryPatients diagnosed in the early stages benefit most from mesothelioma surgery. It offers them the best chance at living longer lives. These procedures, often performed with chemotherapy, remove all visible tumors from the chest area and improve quality of life. -
RadiationRadiation therapy controls symptoms when surgery is not an option. It eases symptoms such as chest pain and discomfort. Radiation can also reduce the risk of local recurrence when combined with surgery, and it can be used as a palliative procedure. -
ChemotherapyDoctors may recommend chemotherapy to mesothelioma patients deemed ineligible for surgery. Chemotherapy also helps extend survival rates. A 2016 Wayne State University study found patients given a chemo drug combination lived three times longer than patients without it. -
Multimodal TherapyMultimodal therapy, which is also known as multimodality treatment, is the combination of two or more conventional treatments to treat the pleural and peritoneal types of mesothelioma. This combined approach controls cancer growth better than using only one treatment.
Treatments for Pleural Mesothelioma
Extrapleural Pneumonectomy (EPP)
EPP removes the entire cancerous lung and all nearby areas where mesothelioma spreads. This includes nearby lymph nodes, the chest lining, heart lining and diaphragm.
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Pleurectomy Decortication (P/D)
P/D spares the lung and only removes cancerous parts of the pleural lining, the chest wall lining, heart lining and the diaphragm. Although a less aggressive surgery, it is still a major surgery.
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Hyperthermic Intrathoracic Chemotherapy (HITHOC)
An experimental procedure that delivers heated chemotherapy drugs throughout the chest cavity. This procedure is performed after a surgeon has removed visible cancer growth through surgery.
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External Beam Radiation Therapy
EBRT is the most common form of radiation for treating mesothelioma. A machine placed outside the body delivers X-ray beams to kill cancer cells. Doctors may use EBRT before or during surgery.
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Brachytherapy
Instead of using an external radiation source, this type of internal radiation uses a radioactive implant to kill nearby cancer cells. Brachytherapy can be used with other conventional treatments.
Read MoreTreatments for Peritoneal Mesothelioma
Peritoneal mesothelioma forms on the peritoneum, which is the tissue lining the abdominal cavity. While this type of mesothelioma can be treated with all conventional treatment options, a combination of heated chemotherapy and surgery works best.
Cytoreductive Surgery
Removes cancerous growths from lining of the abdomen. HIPEC often follows this treatment.
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Heated Intraperitoneal Chemotherapy (HIPEC)
This is the most effective mesothelioma treatment option for this type of the cancer. Doctors deliver heated chemotherapy drugs into the abdominal cavity after surgery. The process kills remaining cancer cells.
Read MoreMesothelioma doctors specialize in treating different disease types, including pleural and peritoneal mesothelioma. These specialists can provide the best treatment plans for you or your loved one.
Palliative Care for Mesothelioma
Common palliative procedures for mesothelioma include:
- Thoracentesis: Removes fluid buildup around the lungs.
- PleurX catheter: Placement of a small drain to prevent fluid buildup around lungs.
- Pleurodesis: Eliminates space where fluid can develop.
- Radiation: Can shrink tumors to reduce chest pain.
- Paracentesis: This is for peritoneal patients. It removes fluid buildup from abdominal area.
- Pericardiocentesis: Doctors use this for pericardial mesothelioma patients. It removes fluid that collects in the sac surrounding the heart.
A 2016 study in Current Medical Research and Opinion shows earlier palliative care lessens pain at all mesothelioma stages.
Supportive care medicine, a new specialized branch of medicine that reduces pain, increases appetite and boosts morale, is one of the most important aspects of mesothelioma treatment. Moffitt has recently created this program, and every mesothelioma patient should ask to be seen by this type of medical specialist, in addition to a thoracic surgeon and medical oncologist.
What Are the Emerging Treatments for Mesothelioma?
Emerging treatment options for mesothelioma include immunotherapy, photodynamic therapy, virotherapy, gene therapy, cryotherapy and epigenetic therapy.
Mesothelioma doctors and researchers are testing these in clinical trials to ensure safety and efficacy. At some point, these experimental treatments could become conventional treatments.
- Clinical Trials
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Clinical trials are medical studies. They involve patients who take experimental treatments or a combination of new procedures. The goal is to find a cure or improve life expectancy. Doctors and researchers track these studies. Mesothelioma patients are eligible for clinical trials. Some of these studies are free.
Researchers are recruiting patients for these clinical trials:
- Olaparib for Malignant Mesothelioma
- Researchers will investigate if the drug olaparib can shrink tumors in people with certain gene mutations.
- Combining LMB-100 with SEL-110
- The drug LMB-100 kills mesothelioma tumors. But antibodies reduce its effectiveness.
- Pembrolizumab for Pleural Mesothelioma
- Researchers will examine the side effects of pembrolizumab and if it can outperform the standard chemo drugs.
Access the Latest Mesothelioma Clinical Trials - Immunotherapy
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Immunotherapy is a treatment using drugs to boost your immune system to fight cancer. It is also known as biologic therapy. Pembrolizumab (Keytruda) and nivolumab (Opdivo) already treat various cancers. Mesothelioma could be next.
- Photodynamic Therapy
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Doctors inject a light-sensitive drug into the patient. After a few days, they apply a special light on the area, usually via laser, to activate the drug and kill cancer cells.
- Gene Therapy
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Gene therapy involves genetically modifying cells and viruses to control cancer growth. For example, researchers are working on repairing the p53 gene, a tumor-suppressor gene that kills cancer cells before they can replicate.
- Virotherapy
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Virotherapy is a cancer treatment that uses viruses to find and attack cancer cells. Some types of virotherapy involve gene therapy or immunotherapy to make the treatment more effective.
- Epigenetic Therapy
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This therapy uses drugs to repair expressions of DNA that cause cells to turn cancerous. Clinical trials in pleural mesothelioma patients show mixed results, but some patients have entered remission for years.
- Cryotherapy
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Cryotherapy is a minimally invasive surgical procedure that freezes cancer cells to kill them. It can be used before major surgery to shrink tumors, after surgery to treat recurrences or as a palliative treatment to control symptoms.
- PleurX Catheter
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Patients with pleural effusion may need a PleurX catheter, which allows them to drain pleural fluid at home rather than at the hospital. Once in place, a home health nurse can drain the fluid and teach patients how to do it themselves.
Complementary and Alternative Treatments
Most mesothelioma patients choose complementary and alternative medicine to improve their health. These are best used alongside conventional treatments and with a doctor’s approval.
Common types of alternative treatments include:
- Herbal medicines
- Mind-body therapies
- Body-based therapies
- Emotional therapies
A great way to find out which complementary treatments have worked for other patients is to ask questions at a mesothelioma support group meeting.
Nutrition
As a part of any treatment plan, patients should maintain a balanced diet in order to maintain weight and energy.
A diet rich in protein and high in calories is best for mesothelioma patients. Following proper nutrition guidelines and advice from a dietitian can help patients improve their well-being and recovery time.
What Is the Cost for Mesothelioma Treatment?
The average cost for treating malignant pleural mesothelioma is similar to that of lung cancer. The National Cancer Institute shows treatments for lung cancer can cost $60,709 in the first year.
An exact cost is difficult to estimate. Every case is unique, and each type of therapy carries its specific expense. Early financial planning could ease some of these concerns about paying for treatment.
Average mesothelioma treatment costs by type of therapy:
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Surgery$26,235
A 2011 National Cancer Institute study shows a stage 1 lung cancer patient could pay $26,235 a month for surgery. Not all mesothelioma patients are eligible for surgery. A late diagnosis means surgery is not helpful.
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Chemotherapy$40,102
A 2013 study comparing pemetrexed plus cisplatin shows the combination costs $40,102. Final chemotherapy costs depend on type of cancer, drugs used and the patient.
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Radiation$9,000
A 2015 study in the Journal of Oncology Practice shows the median cost for a course of radiation for lung cancer patients was $9,000. Total cost depends on your health coverage and the number of treatments you receive.
Mesothelioma Specialists
There are several mesothelioma specialists who have spent years treating this rare disease. They also continue learning about the latest treatment options.
Mesothelioma Specialty Centers
Every cancer is different, and mesothelioma treatments vary by state. Mesothelioma patients should find a center specializing in the treatment of this rare cancer. In fact, the best cancer centers offer a multidisciplinary approach to treating mesothelioma.
What Do Top Mesothelioma Centers Offer Patients?
- A multidisciplinary approach to mesothelioma treatment
- Customized mesothelioma treatment plans
- Mesothelioma tumor boards
- Services for veterans with mesothelioma
- Support services for patients and caregivers
Top Mesothelioma Centers Include
Watch: Leading mesothelioma expert Dr. David Sugarbaker explains why it is so important to seek care from a mesothelioma specialty center.
Common Questions About Mesothelioma Treatment
- What are the main types of treatment for mesothelioma?
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The primary types of mesothelioma treatment included chemotherapy, surgery, radiation therapy and multimodal therapy, which is a combination of two or more of these treatments. New treatments, such as immunotherapy and gene therapy, are available through clinical trials.
- Are there any new treatment types that have shown to be effective for mesothelioma?
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Yes. The FDA approved a new type of treatment called Tumor Treating Fields for pleural mesothelioma in May 2019. Average survival is around one year for mesothelioma with chemotherapy. Adding Tumor Treating Fields to chemotherapy helps patients extend average survival by six months.
- Are there doctors who specialize in mesothelioma?
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There are specialized oncologists, surgeons and other types of doctors who have extensive experience treating mesothelioma. These doctors can confirm a mesothelioma diagnosis and develop an effective treatment plan for a particular type of mesothelioma.
- Will a COVID-19 diagnosis affect my mesothelioma treatment?
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Yes, developing COVID-19 could delay cancer treatments such as chemotherapy, surgery or immunotherapy. Due to the severe effects of COVID-19, patients must first recover from infection before their doctor can continue treating mesothelioma.
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