Best treatments for mesothelioma include surgery, chemotherapy and radiation therapy. Immunotherapy and targeted therapy may be recommended for advanced mesothelioma. Palliative care may improve quality of life and manage symptoms.
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Mesothelioma treatments include surgery to remove tumors, chemotherapy and radiation. Advances in immunotherapy offer promising results that may extend the survival of patients with pleural mesothelioma.
Localized therapies for mesothelioma such as tumor removal surgery and monoclonal antibody therapy directly treat mesothelioma tumors in the body. Systemic therapies, including chemotherapy and immunotherapy, treat the entire body to remove mesothelioma tumors. Some treatments have both localized and systemic applications such as radiation therapy. External beam radiation is localized, but other forms of radiation therapy are systemic.
Types of Mesothelioma Treatments
Chemotherapy
Emerging treatments
Immunotherapy
Multimodal surgeries
Palliative surgeries
Radiation therapy
Tumor-removing surgeries (cytoreductive or debulking surgeries)
Chemotherapy with drugs such as cisplatin, Alimta (pemetrexed) and carboplatin was long the front-line systemic standard of care for pleural mesothelioma. Evidence supports targeted therapy, particularly Avastin (bevacizumab) infusions, to extend survival time with patients who are also receiving chemotherapy with Alimta (pemetrexed) and cisplatin for mesothelioma.
Consider what is most important to you when looking for a mesothelioma specialist. Our Patient Advocates can help you determine if a doctor’s specific experience and track record of success is the best fit for your treatment needs.
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Mesothelioma surgery is a medical procedure involving removal of tumors, damaged tissue or fluid buildup. It can include removing a whole or part of a lung, for example, and aims to reduce tumor mass and symptoms.
Benefits of mesothelioma surgery include extending life expectancy, reducing symptoms and improving quality of life. There are also risks associated with surgery. These include infection, bleeding and damage to surrounding tissues. Discuss goals with your doctor to determine if surgery is the right choice for you.
Types of Mesothelioma Surgery
Cytoreductive Surgery with Heated Chemotherapy
Extrapleural Pneumonectomy
Pleurectomy and Decortication
Not all patients are eligible for surgery. Patients eligible for mesothelioma surgery most often include those in good overall health. They tend to have early-stage mesothelioma with removable tumors.
In 2023, we asked more than 220 survivors, caregivers, and loved ones a variety of questions as part of The Mesothelioma Center’s survey. About 40% to 50% of respondents were eligible for surgery. Among survey respondents, 18% had mesothelioma surgery. Of the group we surveyed who experienced remission, 25% underwent surgery.
I feel that surgery first, followed by chemotherapy, is the best multimodality approach for mesothelioma. [Chemotherapy] may be helpful, but it never gets rid of it. So rather than take that chance, I’d rather get it out first [using surgery].
Chemotherapy
Chemotherapy uses powerful anti-cancer drugs to kill mesothelioma cells, shrink tumors or prevent their growth. It can improve quality of life and may help patients with mesothelioma live longer after treatment. Chemotherapy can be used for both pleural and peritoneal mesothelioma.
Common Mesothelioma Chemo Drugs
Alimta (pemetrexed)
Carboplatin
Cyclophosphamide
Doxorubicin
Gemzar (gemcitabine)
Platinol (cisplatin)
Raltitrexed
Vinorelbine
As a standard treatment for patients ineligible for surgery, chemotherapy is an option for patients with any stage of mesothelioma. Those with advanced-stage mesothelioma or who aren’t surgical candidates may benefit most.
Among respondents to our survey, 32% received chemotherapy, more than any other mesothelioma treatment. In our survey, Alimta and cisplatin were the 2 most common chemotherapy medications patients received.
Radiation therapy uses high-energy radiation to destroy cancer cells and shrink tumors, often in combination with other therapies or after surgery. The benefits of radiation include reduced symptoms and an extended life expectancy. However, it can also cause fatigue, skin irritation and damage to healthy cells.
Most Common Mesothelioma Radiation
Brachytherapy
Intensity-modulated radiation therapy
Photoradiation therapy
Volumetric-modulated arc therapy
Radiation is often an option for patients who aren’t eligible for surgery or chemotherapy. Even if you already had surgery to remove mesothelioma tumors, you may still be eligible for radiation therapy.
Patients eligible for radiation therapy include those with localized or advanced-stage mesothelioma. However, only 12% of those we surveyed received radiation.
Mesothelioma immunotherapy activates your body’s immune cells to locate and destroy mesothelioma cancer cells. The combination of Opdivo (nivolumab) and Yervoy (ipilimumab) works with your immune system to attack malignant mesothelioma that can’t be surgically removed.
Immunotherapy has revolutionized survival for patients with cancers that were historically very difficult to treat, like mesothelioma.
Many patients have fewer or less severe side effects with immunotherapy than with chemotherapy. Side effects can include fatigue and skin rashes. In some cases, inflammation can affect sensitive organs.
In our unique survey, 26% of people said they received mesothelioma immunotherapy, the second-highest response. Of patients who experienced remission, 17% had undergone immunotherapy. Opdivo and Yervoy were the two most common mesothelioma immunotherapy drugs respondents took.
Pleural Mesothelioma Survivor Thrives in Immunotherapy Trial
John Fiala, a Navy veteran who served aboard the USS Saratoga, was told his mesothelioma was too advanced for surgery. Chemo initially stopped tumor progression, then it restarted. A clinical trial for Opdivo and Cyramza is working exceptionally well for him. He raves about guidance from Patient Advocate Amy Pelegrin and VA-accredited claims agent Aaron Munz at The Mesothelioma Center.
Multimodal therapy for mesothelioma combines a mix of treatment approaches, such as surgery, chemotherapy and radiation. One treatment is often not enough to control the cancer, but a combination of treatments gives the patient a better chance of living longer.
Thoracic surgeon Dr. Jacques Fontaine explained to us how multimodal teams work. “Thoracic surgeons, medical oncologists, radiation oncologists, pathologists who all work together under one roof as a team,” he said. “That’s what major mesothelioma centers offer: different specialists from different disciplines all working to care for one patient.”
Multimodal Mesothelioma Treatments
Chemotherapy
Clinical trials
Immunotherapy
Palliative treatment
Radiation therapy
Surgery
Targeted therapy
People diagnosed with an early stage of cancer and who are otherwise healthy are the best candidates for multimodal treatment. Those with other diseases or poor health may be unable to tolerate the side effects of multiple treatments.
Multimodal therapy is different for everyone. “Mesothelioma treatment is quite complex,” Fontaine told us. Doctors look at each patient’s unique diagnosis to create the best plan. Depending on your response, your doctor may add or remove therapies throughout your treatment journey.
Palliative care aims to reduce symptoms and side effects of treatment to improve a patient’s quality of life. It often includes pain management and traditional mesothelioma therapies at low doses. For example, low-dose chemotherapy can help shrink tumors before aggressive mesothelioma surgery. Surgery to place a shunt or catheter can help drain fluids from the chest cavity to make breathing easier.
“Palliative care is becoming a bigger topic these days, especially in cancer. It’s comfort care, but it’s also pain management. It’s something a patient can do and start from the beginning on the day they’re diagnosed,” said Director of Hospice Care Amy Pelegrin. “I recommended it because I just don’t see a need for a patient to suffer or be in pain when they don’t have to be.”
Palliative Therapies for Mesothelioma
Alternative therapies
Catheter or shunt placement
Immunotherapy
Low-dose chemotherapy
Pain medication
Pleurodesis
Respiratory therapy
A mesothelioma palliative care team can include oncologists, surgeons, nurses, pain experts, physical therapists and dietitians. These specialists work together to ensure you receive the best and most appropriate care possible. That may include exercise, physical or respiratory therapy or even alternative therapies such as acupuncture, massage and relaxation techniques. These can help reduce symptoms of mesothelioma and improve overall quality of life.
Supportive therapy for mesothelioma includes nutritional support and mental health care. It aims to enhance a patient’s overall well-being during treatment. Proper nutrition can boost immune function and maintain strength. Mental health support, including counseling and stress management, helps patients navigate the emotional challenges of mesothelioma.
Mesothelioma clinical trials test new and emerging treatments and ways to improve existing treatments. Participation offers a unique opportunity to access cutting-edge therapies, particularly benefitting those who have exhausted or are ineligible for other treatments. Your doctor can help determine if you’re eligible and find an open trial.
Mesothelioma vaccine therapy, for example, is only available through clinical trials. Cancer vaccines help the immune system recognize antigens on cancerous cells and kill them.
Patients with mesothelioma and other types of cancer can get access to emerging technologies and newer types of treatments through clinical research trials. Clinical trials are the best way to find out what’s happening in cancer technology, cancer therapy, and getting access to new ideas and procedures that may not be available to everyone just yet.
Emerging treatments such as Tumor Treating Fields could lead to improved survival. Another promising treatment being tested is Ofev, a pulmonary fibrosis drug that has reached phase III in the clinical trial process for treating pleural mesothelioma.
Some scientists believe that just as damaged genes can cause cancer, changing genes in the right way with mesothelioma gene therapy might help treat it. Suicide gene therapy involves modifying a virus or bacterium, for example, E. coli, to deliver a cancer-killing gene inside mesothelioma cells.
Find a Mesothelioma Specialist
Get specialized treatment from experienced mesothelioma doctors.
One of your first steps following a mesothelioma diagnosis is finding a top doctor and cancer center. It’s essential to do this as soon as possible, as cancer treatment is more effective the earlier you receive it.
A mesothelioma diagnosis can feel overwhelming for you and your loved ones. Remember treatment options are available and our Patient Advocates are here to guide you through the next steps of your mesothelioma journey.
In addition to offering support in finding mesothelioma specialists, our Patient Advocatess can help you navigate insurance, file VA claims and access other resources to cover treatment costs. They can also schedule appointments and share information about clinical trials for new and emerging treatments.
Key Facts About Mesothelioma Treatment
Treatment options for malignant mesothelioma include surgery, radiation therapy, chemotherapy, multimodal therapy and immunotherapy.
About 25% of respondents to The Mesothelioma Center’s recent survey said they’d tried immunotherapy.
Palliative care focuses on symptom management and quality of life.
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Landau, D. A. (2024, August 29). Mesothelioma Treatment. Asbestos.com. Retrieved September 6, 2024, from https://www.asbestos.com/treatment/
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Dr. Jacques Fontaine is a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida, where he heads up the Mesothelioma Research and Treatment Center. He specializes in minimally invasive robotic surgery and aggressive surgeries for mesothelioma.
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