How Is Mesothelioma Treated?
Treatments for all types of mesothelioma aim to remove tumors or kill cancer cells. Surgery removes tumors, while chemotherapy and radiation kill cancer cells. Immunotherapy can extend the survival of patients with pleural mesothelioma.
Key Facts About Mesothelioma Treatment
- Primary treatment options include surgery, chemotherapy, radiation therapy and immunotherapy.
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About 27.6% of pleural patients qualified for surgery between 2004 and 2020, according to the National Cancer Database.
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Immunotherapy and chemotherapy are effective treatments for advanced cases.
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Clinical trials offer access to emerging therapies.
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Palliative care focuses on symptom management and quality of life.
Localized therapies directly treat mesothelioma tumors in the body. Examples include tumor removal surgery and monoclonal antibody therapy. Systemic therapies, like chemotherapy and immunotherapy, treat the entire body. Chemotherapy has been the front-line systemic standard of care for mesothelioma. Evidence supports the addition of targeted therapy to extend survival time with chemotherapy.
Consider what is most important to you when looking for a mesothelioma specialist. Our Patient Advocates can help you find the right doctor. They will check if the doctor has the right experience and a successful track record.
Primary Types of Mesothelioma Treatment
The primary types of mesothelioma treatment include surgery, chemotherapy, radiation and immunotherapy. One treatment is often not enough to control the cancer, but a combination of treatments gives the patient a better chance of living longer.
Multimodal therapy for mesothelioma combines treatments to improve patient outcomes. People diagnosed with an early stage of cancer 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,” says thoracic surgeon Dr. Jacques Fontaine. 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.
Surgery
Mesothelioma surgery removes tumors, damaged tissue and fluid buildup. The goal is to remove as much cancer as possible to improve survival. 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
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Extrapleural Pneumonectomy
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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.
Peritoneal mesothelioma survivor Susan Dickman was diagnosed with stage 4 cancer in 2012 and was told she didn’t qualify for surgery. She sought a second opinion with surgical oncologist Dr. Edward Levine, who believed she could benefit from sugery with heated chemotherapy. “We chose a doctor who had done more of these surgeries than anybody else. Numbers count for any surgery,” said Dickman.
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 different cell types associated with pleural and peritoneal mesothelioma.
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. It may be delivered systemically or locally to target the mesothelial lining.
Common Mesothelioma Chemo Drugs
- Alimta (pemetrexed)
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Carboplatin
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Cyclophosphamide
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Doxorubicin
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Gemzar (gemcitabine)
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Platinol (cisplatin)
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Raltitrexed
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Vinorelbine
Some patients qualify to receive another drug or therapy while undergoing chemotherapy. The addition of a targeted drug, such as Avastin (bevacizumab), or Tumor Treating Fields can improve survival.
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.
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Radiation Therapy
Radiation therapy uses high-energy radiation to kill mesothelioma cells and shrink tumors. It is often combined with other therapies or delivered after surgery to prevent recurrence. 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
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Intensity-modulated radiation therapy
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Photoradiation therapy
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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.
Immunotherapy
Immunotherapy for mesothelioma activates your body’s immune cells to locate and destroy cancer cells. The combination of FDA-approved 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.
Mesothelioma survivor Barbara Lappala says her survival is thanks to Keytruda (pembrolizumab), an immunotherapy drug she receives systemically every three weeks. “I tell people today, I’m a walking miracle,” said Lappala, who was diagnosed in 2018. “They don’t believe in miracles. Then they see me.”
Survivor Story
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.
Read John’s Story
Emerging Treatments and Clinical Trials
Mesothelioma clinical trials test new and emerging treatments. They also test ways to improve existing treatments, including new combinations in multimodal therapy.
Participation offers a unique opportunity to access cutting-edge therapies. Clinical trials can benefit those who have exhausted or are ineligible for other treatments. Your doctor can help determine if you’re eligible and find an open trial.
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.
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. 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.
Clinical trials helped to develop a new treatment called Tumor Treating Fields. It is added to chemotherapy to extend survival. Another emerging treatment is Ofev, a pulmonary fibrosis drug that has reached phase III in the clinical trial process for treating pleural mesothelioma.
Palliative Care
Palliative care aims to reduce mesothelioma symptoms and improve a patient’s quality of life. This type of care is beneficial for every stage of mesothelioma. 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.
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 complementary therapies such as acupuncture, massage and relaxation techniques. These can help reduce symptoms of mesothelioma and improve overall quality of life.
Palliative Therapies for Mesothelioma
- Alternative therapies
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Catheter or shunt placement
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Immunotherapy
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Low-dose chemotherapy
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Pain medication
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Pleurodesis
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Respiratory therapy
Mesothelioma survivor Virginia Beach used palliative care when shortness of breath returned 10 years after she underwent chemotherapy. “After a while, the doctor told me my lungs were clear,” Beach said after palliative care. Chemotherapy is the only cancer treatment that has contributed to her long survival. “My oncologist doesn’t say it’s in remission. He says it’s in control,” Beach said.
“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.”
What to Do Next: Finding the Best Mesothelioma Treatment
The best treatment for mesothelioma depends on the cancer’s type and stage, as well as the patient’s overall health. 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.
Common Questions About Mesothelioma Treatment
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What is the most common treatment for mesothelioma?
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Chemotherapy is the most common treatment for mesothelioma. The majority of people with mesothelioma qualify for chemotherapy. Fewer people qualify for surgery and radiation therapy.
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How effective is mesothelioma treatment?
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The effectiveness of mesothelioma treatment depends on many factors. The type of mesothelioma, its stage and a patient’s overall health and age impact treatment outcomes. Combining treatments in multimodal therapy improves life expectancy.
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Can mesothelioma be cured with treatment?
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While no treatment can cure this type of cancer, therapies can improve survival and quality of life. Partial remission is more common with this cancer than full remission. Patients in partial or full remission often receive maintenance therapies. Surgery has the potential to remove most of the cancer. Chemotherapy, immunotherapy and radiation can help control tumor growth and spreading.
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What happens if mesothelioma goes untreated?
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Untreated mesothelioma grows and spreads more quickly than when treated. The growth rate varies based on the cancer’s stage, location, tumor grade and cell type. While some patients may experience a slower progression, most cases progress rapidly.
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What are the common side effects of mesothelioma treatment?
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Common side effects of mesothelioma treatment include fatigue, nausea, mouth sores and loss of appetite. Radiation may cause skin irritation and shortness of breath. Surgery may lead to pain, infection and complications. Immunotherapy can cause flu-like symptoms and rashes.
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