Mesothelioma Treatment

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 common mesothelioma treatment options:

• Surgery
• Chemotherapy
• Radiation
• Multimodal

Clinical trials can also provide patients with emerging therapies. These include immunotherapy, targeted therapy and photodynamic therapy.

Type of mesothelioma, stage, cell type and other factors decide the best treatment.

Treatments for Pleural Mesothelioma

Pleural mesothelioma affects the lining around a person’s lung. This lining is the pleura.

The best pleural mesothelioma treatments include:

Surgery

Patients diagnosed in the early stages benefit most from mesothelioma surgery. It offers them the best chance at living longer lives. These procedures remove tumors from the chest area and improve quality of life.

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  Extrapleural Pneumonectomy (EPP): EPP removes the cancerous lung and all nearby areas where mesothelioma spreads. This can include nearby lymph nodes, parts of 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 and the diaphragm. This is a less aggressive surgery.

Chemotherapy

Doctors may recommend chemotherapy to mesothelioma patients who are not eligible for surgery. This mesothelioma treatment also helps extend survival rates. A 2016 Wayne State University study found patients given a combination of chemo drugs lived three times longer than patients without it.

• Hyperthermic intrathoracic chemotherapy (HITHOC): An experimental procedure that delivers heated chemotherapy drugs throughout the chest cavity.

Radiation

Radiation therapy controls symptoms when surgery is not an option. It eases symptoms such as chest pain and discomfort. And it can also reduce the risk of local recurrence when combined with surgery.

• External Beam Radiation Therapy: Machine placed outside the body delivers X-ray beams to kill cancer cells
• Brachytherapy: Uses a radioactive implant to kill nearby cancer cells

Hyperthermic intrathoracic chemotherapy may help pleural mesothelioma patients, too. It delivers a heated chemo drug treatment to the chest cavity after surgery.

Mesothelioma doctors are testing and improving this procedure.

Treatments for Peritoneal Mesothelioma

Peritoneal mesothelioma forms on the tissue lining the abdomen. This lining is also known as the peritoneum.

The best peritoneal mesothelioma treatments include:

• 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.

• Cytoreductive Surgery: Removes cancerous growths from lining of the abdomen. HIPEC often follows this treatment.

Conventional mesothelioma treatments, including radiation, may also help peritoneal mesothelioma patients.

Quick Fact:

HIPEC helped 3 out of 4 patients survive at least five years after the procedure.

What Is Multimodal Therapy?

Multimodal therapy combines two or more conventional treatments. Another name for this therapy is multimodality treatment.

The 2018 ASCO mesothelioma guidelines show multimodal therapies resulted in an overall survival of 13 to 23.9 months.

Understanding Palliative Care for Mesothelioma

Palliative treatment is also known as supportive care.

It can improve quality of life and relieve symptoms from the cancer and its therapies.

Common palliative procedures for mesothelioma include:

• Thoracentesis: Removes fluid buildup around the 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.

What Are the Emerging Treatments for Mesothelioma?

Emerging treatment options for mesothelioma include immunotherapy, photodynamic therapy, virotherapy, gene therapy, cryotherapy and epigenetic therapy. The NovoTTF-100L system, which the FDA approved in May 2019, is the newest first-line treatment for mesothelioma since 2004.

Researchers are testing these in clinical trials to ensure safety and efficacy. At some point, these experimental treatments could become conventional treatments.

Clinical Trials

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 cause 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. Researchers will add the drug SEL-110 to see if it prevents antibodies from forming.

• Pembrolizumab for Advanced Pleural Mesothelioma: Researchers will examine the side effects of pembrolizumab and if it can outperform the standard chemo drugs.

Immunotherapy

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

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

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

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.

NovoTTF-100L System

The Tumor Treating Fields system is the first mesothelioma treatment to be approved by the FDA in 15 years. It uses electric currents to stop cancer cells from growing and spreading.

Epigenetic Therapy

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

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

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 the patient 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 what has worked for other patients is to ask questions at a mesothelioma support group meeting.

Maintaining a well-balanced diet through proper nutrition helps recovery. Eating the right foods before, during and after treatment can improve your well-being.

Eating right and balancing your diet while undergoing mesothelioma treatment can help ease your symptoms.

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 and lung cancer is similar. The National Cancer Institute shows treatments for lung cancer can cost $60,709 in the first year.

Cost is difficult to estimate. Every case is unique, and each type of therapy carries its specific expense.

Average mesothelioma treatment costs by type of therapy:

Chemotherapy: 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.

Radiation: 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.

Surgery: 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.

These costs may create stress for mesothelioma patients and their loved stress. Early financial planning could ease some of these concerns about paying for treatment.

Specialized mesothelioma lawyers can advise patients on whether they can receive legal compensation to cover the cost of treatment.

Mesothelioma Specialists

There are several mesothelioma specialists who have spent years treating this rare disease. They also continue learning about the latest treatment options.

The most common specialty mesothelioma doctors include:

• Oncologists: The primary doctor who oversees a mesothelioma patient’s care. They will plan any chemotherapy and coordinate with other doctors.

• Thoracic Surgeon: These doctors train under other mesothelioma surgeons for years. The training sets them up to perform these complex surgical procedures.

Mesothelioma Specialty Centers

Every cancer is different and so is every mesothelioma treatment center.

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.

Patients at these centers have a team of doctors from different specialties, not one.

Some of the top mesothelioma specialists work at these types of centers.

For example, Dr. Jacques Fontaine is at the Moffitt Cancer Center in Tampa. Fontaine trained under the late mesothelioma pioneer Dr. David Sugarbaker.

Dr. Abraham Lebenthal works at Brigham and Women’s Hospital in Boston. He also studied under Sugarbaker.

Thankfully, there are several experienced mesothelioma specialists at centers across the U.S., including at some VA hospitals that serve veterans with mesothelioma.

It’s important to remember there is no one-size-fits-all approach to treating mesothelioma.

An early diagnosis offers the best chances of survival with cancer caused by asbestos. It also helps to develop a treatment plan with your multidisciplinary team and a strong support system including caregivers, family and friends.