Mesothelioma Treatment Options

Although there is no definitive cure for mesothelioma, survivors are living longer thanks to advances in therapy and a multidisciplinary, patient-specific approach to treatment. Mesothelioma treatment plans typically consist of a combination of surgery, chemotherapy and radiation therapy and may include experimental treatments such as immunotherapy.

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Key Stats

Mesothelioma Treatment

  • Surgery Can more than double survival
  • Chemotherapy Patients survive three times longer
  • Multimodal Therapy Combination of surgery, chemotherapy and possibly radiation therapy
  • Immunotherapy Enhances immune system response to mesothelioma
  • Alternative Treatments Treats the cancer’s effects on the mind and body
  • Cost for Treatment Comparable to average lung cancer treatment costs of $60,709

There was a time when the only option for mesothelioma patients was palliative treatment, with the goal of relieving pain and other symptoms to improve quality of life.

After years of research and emerging technologies, many mesothelioma patients can now improve their prognosis through the latest groundbreaking treatments.

The treatments you receive will vary depending on the following factors:

  1. Cancer Stage

    How much the tumors have spread throughout the body.

  2. Cell Type

    These microscopic features of the disease respond differently to treatment and affect the way the cancer spreads.

  3. Types of Mesothelioma

    There are four types of mesothelioma, each affecting different areas of the body.

  4. Overall Health

    Older patients or those in poor health may not be eligible for certain aggressive surgeries.

When tumors are contained at or near the point of origin, a combination of surgery, chemotherapy and possibly radiation therapy likely will be offered. This combined approach to treatment is called multimodal therapy.

If the mesothelioma already has spread significantly, doctors typically recommend palliative treatments that can help alleviate pain, breathing problems and other cancer symptoms that lessen your quality of life. Chemotherapy and radiation are still likely to be offered in an effort to contain the spread and growth of the cancer, but probably not aggressive surgery options.

Dr. Jacques Fontaine sits down exclusively with Asbestos.com to talk about the treatment options available for mesothelioma patients.

Less invasive surgeries are available to drain fluid that builds up in the chest or abdomen, alleviating troublesome symptoms.

Many mesothelioma patients turn to clinical trials to test emerging treatments such as immunotherapy, gene therapy and the combination of different chemotherapy drugs.

It all starts with finding a qualified mesothelioma specialist. Mesothelioma represents only 0.3 percent of all cancers, so finding a cancer center with a staff that understands the intricacies of the rare asbestos-related cancer is essential.

“The benefit [of a tumor board or multidisciplinary care] is that you can get a room full of feedback from multiple disciplines focused on your individual diagnosis.”

Dr. Jacques Fontaine, Thoracic Surgeon at Moffitt Cancer Center

Common Types of Mesothelioma Surgery

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Surgery is used to treat and diagnose mesothelioma. Major surgeries aim to remove as much cancerous growth as possible, while palliative procedures control symptoms.

Aggressive Mesothelioma Surgeries

Although no mesothelioma surgery is considered curative, aggressive procedures are typically a patient’s best chance at long-term survival.

The following are the most common surgeries for treating malignant pleural mesothelioma.

Extrapleural Pneumonectomy (EPP)

Removal of an entire lung, the lining around it, and parts of the heart lining, nearby lymph nodes and diaphragm.

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Pleurectomy/Decortication (P/D)

Two-part surgery that meticulously removes the lining of the lung along with any tumors found inside the chest cavity.

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The most common surgery for peritoneal mesothelioma patients is cytoreduction, which removes cancerous growth from the lining of the abdomen. Also known as debulking surgery, this procedure is often followed by hyperthermic intraperitoneal chemotherapy (HIPEC).

A pericardiectomy is the only tumor-removing surgery for pericardial mesothelioma, a rare type of the asbestos-related cancer that forms on the lining of the heart. This procedure aims to remove as much cancerous tissue as possible from the heart lining.

Pleural mesothelioma survivor, Gene Hartline

“[My doctor] told me from the start, ‘We’ll fight this together. We’ll try and come up with something that works for you.’ I was so lucky to find her. Best thing that could have happened to me.”

– Gene Hartline Diagnosed with pleural mesothelioma in 2016

Palliative Mesothelioma Surgeries

Less traumatic surgeries are used if you are not healthy enough to withstand the strain of a major surgery, or if the cancer already has spread. The goal of these surgeries is to relieve symptoms and help you feel better. You may also have chemotherapy and radiation before or after these surgeries.

In some cases, palliative surgeries are performed months or years after aggressive procedures as a way to control recurring symptoms. Although there are several types of palliative mesothelioma surgeries, they all share the same goal: Remove excess fluid from the affected part of the body.

Pleurodesis

Thoracentesis

Paracentesis

Pericardiocentesis

Pleurodesis

Treats pleural effusions by removing fluid from the space between the visceral lining and parietal lining of the lungs and closes the pleural space to prevent further buildup.

Learn About Pleurodesis

Thoracentesis

This older method of treating pleural effusions drains fluid but does not close the pleural space.

Learn About Thoracentesis

Paracentesis

A common option for peritoneal mesothelioma patients, this procedure removes ascites, which is fluid buildup in the abdominal cavity.

Learn About Paracentesis

Pericardiocentesis

Removes excess fluid from the sac that surrounds the heart.

Learn About Pericardiocentesis
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Chemotherapy for Mesothelioma

Chemotherapy treats most types of cancer, including malignant mesothelioma. The drugs kill cancer cells and are usually delivered by an IV.

The standard and most effective first-line chemotherapy regimen for pleural mesothelioma patients is cisplatin and pemetrexed (Alimta). A milder combination of pemetrexed and carboplatin often achieves the same results but with fewer side effects.

Chemotherapy for Peritoneal Mesothelioma

Peritoneal mesothelioma patients may be eligible for intraperitoneal chemotherapy, where drugs are delivered into the abdominal cavity directly.

Quick Fact

In a 2016 study, researchers at Wayne State University found mesothelioma patients who received one of the chemotherapy combinations survived three times longer than patients without chemotherapy.

Also known as heated chemotherapy, HIPEC is given immediately after surgery to kill any remaining microscopic cancer cells. According to 2013 study at Moffitt Cancer Center in Tampa, the median survival rate for peritoneal patients who underwent HIPEC and cytoreductive surgery was 41 months.

Those who returned for a second procedure survived an average of 80 months.

Dr. Paul Sugarbaker

Quick Fact

In a 2017 study led by Dr. Paul Sugarbaker, 75 percent of peritoneal mesothelioma patients survived at least five years after receiving three types of intraperitoneal chemotherapy: Normothermic intraperitoneal chemotherapy (NIPEC), HIPEC and early postoperative intraperitoneal chemotherapy (EPIC).

Side Effects of Chemotherapy

Since chemotherapy drugs affect cancer cells as well as healthy cells, you may feel worse after treatment. Some patients choose not to undergo chemotherapy because of harsh side effects such as nausea, hair loss, fatigue and severe weight loss.

However, negative side effects wear off over time and many patients experience notable improvements. An experienced mesothelioma specialist can help you understand your options and decide the right chemotherapy regimen.

Radiation Therapy

Radiation therapy is noninvasive and uses high-energy rays to target cancer cells. It is typically paired with chemotherapy to help shrink tumors or manage tumor growth. It doesn’t have the strong side effects of chemotherapy, and it often helps reduce the physical pain of mesothelioma. Radiation also can be used in a palliative situation when mesothelioma surgery is no longer an option.

However, because radiation can be toxic to various organs and damages DNA while killing cancer cells, it is used sparingly. Pleural mesothelioma patients are more likely to receive radiation than peritoneal patients because of the location of the cancer.

Peritoneal mesothelioma survivor, Kasie Coleman

“I can’t tell you the amount of people I’ve talked to who are no longer here because they got treated by an oncologist and not a mesothelioma specialist. It happens so often.”

– Kasie Coleman Diagnosed with peritoneal mesothelioma in 2010

Emerging Mesothelioma Treatments

The future of mesothelioma treatment almost certainly involves therapies still being developed. There may be tremendous potential with immunotherapy, gene therapy and photodynamic therapy. All are being used in clinical trials and could become standard treatment at some point.

Immunotherapy

Helps your own immune system fight cancer. Some checkpoint inhibitors, such as pembrolizumab (Keytruda) and nivolumab (Opdivo), are already approved by the U.S. Food and Drug Administration (FDA) for the treatment of various cancers. Mesothelioma could be next.

Gene Therapy

Aims to treat or prevent cancer by injecting genetic material into the body. One form called suicide gene therapy uses a modified virus or bacterium to target and kill cancer cells. Gene therapy is particularly effective for pleural mesothelioma patients given the location of the tumors.

Photodynamic Therapy

Uses light energy to kill cancer cells. Doctors inject a light-sensitive drug into the patient. After a few days, a special light is applied to the area, usually via laser, to activate the drug and kill cancer cells.

Dr. Robert Ramirez

“The advantage of being in a trial is having a whole team looking after you, and not just your doctor. It’s our whole research team looking after a patient.”

Dr. Robert Ramirez Ochsner Cancer Institute oncologist

Alternative Therapies

Complementary and alternative medicine (CAM) options don’t treat the disease itself but focus on the patient mentally, emotionally and physically. They can be used alongside more traditional approaches to cancer treatment.

Massages, acupuncture, yoga, naturopathy and aromatherapy can be used to relieve pain or reduce stress that comes from traditional treatment. Patients in many states have access to medical marijuana, which can help control cancer pain.

Mesothelioma Treatment Timeline

The treatment timeline a patient goes through varies depending on the type and stage of the cancer.

  • Diagnosis

    The doctor usually delivers a diagnosis two to three months after symptoms appear.

  • Biopsy

    Doctor orders a biopsy and recommends a specialist to the person diagnosed. Biopsy confirmation can take up to 10 days.

  • Appointment with Specialist

    It usually takes a week for a surgeon or oncologist to meet with the person diagnosed after biopsy confirmation.

  • More Tests

    Surgeon or oncologist orders additional biopsies, X-rays, CT scans, MRIs, PET scans, stress tests and other examinations to determine stage and surgery eligibility.

  • Treatment Plan

    If the patient is eligible for surgery, the surgeon will schedule the procedure, depending on their availability.

    • Chemotherapy and radiation therapy may be delivered before, during or after surgery.
    • Follow-up CT scans track the success of surgery and determine if additional treatments are needed.
    • Doctor creates a pain management plan to help the patient cope with discomfort following surgery.

    If patient is not eligible for surgery, they will schedule an appointment with an oncologist for other treatment options, including chemotherapy and radiation.

    • Chemotherapy and radiation therapy may be delivered before, during or after surgery.
    • Follow-up CT scans track the success of surgery and determine if additional treatments are needed.
    • Doctor creates a pain management plan to help the patient cope with discomfort following surgery.
  • Leading Mesothelioma Treatment Specialists

    The top specialists work at recognized mesothelioma centers. Some of the best known mesothelioma specialists, such as Dr. David Sugarbaker at the Lung Institute at Baylor College of Medicine in Houston, trained young surgeons who have moved on to other cities and treatment centers.

    Dr. Jacques Fontaine at the Moffitt Cancer Center in Tampa and Dr. Abraham Lebenthal at Brigham and Women’s Hospital in Boston took Sugarbaker’s expertise to others around the country.

Dr. Paul H. Sugarbaker

Dr. Paul H. Sugarbaker

Director of the Peritoneal Surface Malignancy Program at Washington Cancer Institute

Contact Dr. Sugarbaker
Dr. Robert Cameron

Dr. Robert Cameron

Director of Thoracic Surgery at UCLA Jonsson Comprehensive Cancer Center

Contact Dr. Cameron
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What Is the Average Cost for Mesothelioma Treatment?

Mesothelioma treatment can be expensive if you don’t have health insurance or financial resources. Cost is difficult to pinpoint because every diagnosis is unique.

Chemotherapy costs vary depending on the type of cancer, the drugs used and patient-specific factors. The total cost for pemetrexed (Alimta) plus cisplatin — the most used chemotherapy combination for first-line treatment of mesothelioma — was $40,102, according to a 2013 cost effectiveness study comparing the drug pair with other chemotherapy regimens.

The estimated monthly cost of radiation therapy is $2,000; however, the total expense depends on your health coverage and the number of treatments you receive. According to a 2015 study published in the Journal of Oncology Practice, the median cost of a course of radiation therapy for lung cancer patients was $9,000.

$60,709

According to recent projections, this is the average cost of lung cancer treatment, which is comparable to mesothelioma, during the initial year after diagnosis Source: National Cancer Institute

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Karen Selby, RN and Patient Advocate at The Mesothelioma Center

Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Sources
  1. National Cancer Institute. (2016, October 14). Malignant Mesothelioma Treatment (PDQ)–Health Professional Version. Retrieved from https://www.cancer.gov/types/mesothelioma/hp/mesothelioma-treatment-pdq#section/29
  2. De Perrot, M. et al. (2009, March). Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. Retrieved from http://ascopubs.org/doi/abs/10.1200/jco.2008.17.5604?keytype2=tf_ipsecsha&ijkey=cc3963ea9a3a4bb5b4de2a5ed1215dfe6c125413&
  3. Munkholm-Larsen, S., Cao, C. Q., and Yan, T. D. (2009). Malignant pleural mesothelioma. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999110/?tool=pubmed
  4. Stahel, R.A., Weder, W., Lievens, Y., and Felip, E. (2010). Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Retrieved from http://annonc.oxfordjournals.org/content/21/suppl_5/v126.long
  5. National Cancer Institute. (2011, January). Annualized Mean Net Costs of Care. Retrieved from https://costprojections.cancer.gov/annual.costs.html
  6. Shah, M. et al. (2013, August 7). Cost effectiveness of first-line pemetrexed plus platinum compared with other regimens in the treatment of patients with nonsquamous non-small cell lung cancer in the US outpatient setting. Retrieved from http://www.sciencedirect.com/science/article/pii/S0169500213003309
  7. Glover, L. (2016, March 8). How Much Does Chemotherapy Cost. Retrieved from https://www.nerdwallet.com/blog/health/medical-costs/how-much-does-chemotherapy-cost/
  8. Paravati, A. et al. (2015, August 11). Variation in the Cost of Radiation Therapy Among Medicare Patients With Cancer. Retrieved from http://ascopubs.org/doi/abs/10.1200/JOP.2015.005694
  9. Schil, P. et al. (2014, August 31). Multimodal management of malignant pleural mesothelioma: where are we today? Retrieved from http://erj.ersjournals.com/content/44/3/754
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