Mesothelioma Treatment

Treatment helps people live longer with malignant mesothelioma. While a curative treatment outcome is rare, a treatment approach called multimodal therapy can help certain patients live for years with the cancer.

Multimodal therapy combines treatments to kill cancer cells in multiple ways. Specialists consider it the best treatment for mesothelioma.

Patients diagnosed in an early stage often qualify for a combination of surgery, chemotherapy and radiation therapy. Multimodal therapy for late-stage patients may involve chemotherapy and immunotherapy.

The most common treatment options for mesothelioma include:

• Surgery
• Chemotherapy
• Radiation therapy

New and experimental therapies are available through clinical trials. Some of these therapies include targeted therapy, immunotherapy and photodynamic therapy.

Different types of mesothelioma require specialized treatment. Varying surgeries and chemotherapy drugs are used in malignant pleural mesothelioma treatment compared to peritoneal mesothelioma treatment.

Mesothelioma life expectancy without treatment is around four to six months for the average patient diagnosed in stage 3 or stage 4. Electing treatment at these stages often helps patients live at least a year.

Those diagnosed in stage 1 or stage 2 who undergo aggressive treatment may live for years with mesothelioma.

What Are the Current Types of Mesothelioma Surgery?

The current types of surgery for pleural mesothelioma include extrapleural pneumonectomy (EPP) and pleurectomy and decortation (P/D). A thoracotomy is the first part of an EPP or P/D surgery. This allows doctors to operate on organs inside the chest. Surgeons may also use a diagnostic procedure called video-assisted thoracoscopic surgery (VATS), which is inserting a tiny camera through a small cut in the chest to see the lung. VATS allows doctors to see inside the chest and take biopsy samples. The primary surgery for peritoneal mesothelioma is cytoreductive surgery, also known as debulking surgery.

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.

Learn More About EPP Mesothelioma Surgery

Pleurectomy and Decortication (P/D)

P/D spares the lung and only removes cancerous parts of the pleural lining, the chest wall lining and the diaphragm.

Learn More About Pleurectomy And Decortation (P/D)

Cytoreductive Surgery

Cytoreductive surgery removes cancerous growths from the lining of the abdomen. Also known as debulking surgery or peritonectomy, this procedure is often followed by heated chemotherapy.

Learn More About Cytoreductive Surgery

What Are the Chemotherapy Options for Mesothelioma?

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

These drugs are usually delivered with an IV into the bloodstream. Sometimes, doctors heat up chemotherapy drugs and deliver them locally after surgery rather than throughout the bloodstream.

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.

If the cancer grows, patients may undergo second-line chemotherapy with other drugs, including:

• Carboplatin
• Gemcitabine
• Doxorubicin

Other chemotherapy drugs tested on mesothelioma have included onconase, navelbine, raltitrexed and mitomycin.

HIPEC

Heated Intraperitoneal Chemotherapy (HIPEC) is the most effective treatment option for peritoneal mesothelioma patients.

In this procedure, heated chemotherapy drugs are delivered directly into the abdominal cavity after cytoreductive surgery to kill remaining cancer cells.

According to a 2013 study at Moffitt Cancer Center in Tampa, Florida, 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.

Intraperitoneal chemotherapy may also be administered without surgery and with the chemotherapy at normal room temperature.

HITHOC

Hyperthermic intrathoracic chemotherapy (HITHOC) is an experimental version of HIPEC for people with pleural mesothelioma.

HITHOC delivers heated chemotherapy throughout the chest cavity after a pleurectomy and decortication.

Currently, HITHOC is not as successful as HIPEC, but doctors are optimistic the procedure can be improved. Several studies have reported longer survival among patients who received HITHOC.

Other Mesothelioma Treatment Options

Chemotherapy and surgery are primarily used to prolong survival, while radiation therapy and other therapies are primarily used to control symptoms. However, radiation therapy can reduce the risk of local recurrence in addition to improving chest pain.

Radiation Therapy

Radiation therapy uses high-energy particles or waves, such as X-rays, gamma rays or protons, to target cancer cells.

It is used to control chest pain by shrinking mesothelioma tumors that are pressing against the chest wall. When combined with surgery, radiation therapy can reduce the risk of local recurrence.

Some doctors apply radiation before surgery to shrink tumors to make them easier to remove.

Radiation often doesn’t have the strong side effects of chemotherapy, and it can help reduce the physical pain of mesothelioma. It is sometimes used palliatively to reduce mesothelioma symptoms when 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 carefully. Pleural mesothelioma patients are more likely to receive radiation than peritoneal patients because it is hard to apply radiation to the abdomen without harming vital organs.

Pleural Mesothelioma Treatment Options

Other mesothelioma cancer treatment options control pleural symptoms and help doctors diagnose the cancer. Noninvasive surgeries are available to drain fluid that builds up in the chest, alleviating troublesome symptoms.

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 More About Pleurodesis

Thoracentesis

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

Learn More About Thoracentesis

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Peritoneal Mesothelioma Treatment Options

In addition to cytoreductive surgery and HIPEC, another treatment option called paracentesis is available to relieve pain and pressure caused by excess abdominal fluid.

Paracentesis

This procedure removes ascites, which is fluid buildup in the abdominal cavity. A tube drains the fluid through a small abdominal incision.

Learn More About Paracentesis

Pericardial Mesothelioma Treatment Options

There are limited treatment options for pericardial mesothelioma, a rare type of the asbestos-related cancer that forms on the linings of the sac around the heart.

Pericardiocentesis

Removes excess fluid from the sac that surrounds the heart using a needle and a thin drainage tube.

Learn More About Pericardiocentesis

Pericardiectomy

A pericardiectomy is a tumor-removing surgery for pericardial mesothelioma. This procedure aims to remove as much cancerous tissue as possible from the linings of the pericardial sac.

Pericardial Window

A pericardial window removes part of the heart lining to drain excess fluid from around the heart.

Complementary Mesothelioma Treatments

Most mesothelioma patients elect complementary therapies that improve their overall health and boost their immune system. Examples include palliative care, alternative therapy and taking care of your physical health.

Palliative Care

Palliative care involves any therapy used to relieve symptoms or improve quality of life.

If the cancer already has spread significantly, doctors typically recommend palliative treatment options for mesothelioma that can help alleviate pain, breathing problems and other cancer symptoms that lessen your quality of life.

Alternative Therapy

Complementary and alternative medicine 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. These types of treatments are not replacements to modern medicine and should not be used in place of a doctor or other medical professional.

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.

Physical Health Care

Many mesothelioma patients take steps to improve their overall health. Some patients focus on their emotional and mental health by joining a support group.

Others change their diet to boost nutrition. Some patients begin a gentle exercise program to lessen fatigue.

Free Mesothelioma Nutrition Guide

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

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New Mesothelioma Treatment Options

Some of the new mesothelioma treatment options in development include immunotherapy and photodynamic therapy. They are being used in clinical trials and could become standard treatment at some point. New treatment for mesothelioma is thoroughly tested in clinical trials to ensure safety and efficacy.

• Clinical Trials

  Many mesothelioma patients are eligible for clinical trials that test emerging treatments. Clinical trials also test new approaches to multimodal therapy and the combination of different chemotherapy drugs.

• Immunotherapy

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

• Photodynamic Therapy

  This 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 Ochsner Cancer Institute oncologist

“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.”

Mesothelioma Specialists

Doctors who specialize in mesothelioma include oncologists and thoracic surgeons. These doctors know how to treat mesothelioma and they often take leadership roles in mesothelioma clinical trials.

Several other types of doctors play supportive roles in mesothelioma care such as radiologists, palliative medicine doctors, pulmonologists, general practitioners, internal medicine specialists and occupational medicine doctors. Treating mesothelioma requires a multidisciplinary approach to cancer care.

Dr. Jacques Fontaine Thoracic Surgeon at Moffitt Cancer Center

“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.”

Oncologist

A small number of oncologists specialize in the diagnosis and treatment of mesothelioma. These oncologists stay up-to-date on all the latest malignant mesothelioma treatment guidelines. Your oncologist will be the primary doctor who oversees your care and any chemotherapy you may receive.

Your oncologist will also coordinate with other doctors involved in your treatment such as your radiologist, surgeon and palliative care doctor.

Thoracic Surgeon

A handful of thoracic surgeons specialize in surgical procedures for mesothelioma. These doctors train under other mesothelioma surgeons for years to acquire the expertise necessary to perform these complex operations.

Gene Hartline Diagnosed with pleural mesothelioma in 2016

“[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.”

Treatment Centers

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.

What Is the Average Cost for Mesothelioma Treatment?

Treatment of malignant mesothelioma can be expensive if you don’t have health insurance or financial resources. Cost is difficult to pinpoint because every case 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, but 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.

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Karen Selby, RN

Registered Nurse and Patient Advocate

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.

Edited by Walter Pacheco

Medical Review By Dr. Don W. Hill

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