MESOTHELIOMA TREATMENT
While no known cure for mesothelioma exists, there are treatment options available which can prolong the lifespan of mesothelioma patients. Mesothelioma treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy or a combination of any of the four, which has proven to be more effective than any one individual treatment alone. The type of treatment depends on the stage of the cancer, the patient's overall health, and the type of mesothelioma. In addition, mesothelioma patients may also try experimental treatments through clinical trials.
SURGERY
The three main types of surgery for mesothelioma include:
Extrapleural Pneumonectomy (EPP)
An EPP involves the removal of the cancerous lung and parts of the lining of the chest, lining of the heart, the diaphragm, and nearby lymph nodes. In general, patients diagnosed with earlier stages of mesothelioma and who are in relatively good health are considered good candidates for this surgery.
Pleurectomy/Decortication (P/D)
The Pleurectomy/Decortication surgery removes the cancer lining of the chest wall, along with any tumors growing inside the chest. This is a less extensive surgery than EPP because the lung is not removed. Like EPP, patients diagnosed with earlier stages of mesothelioma and who are in relatively good health are considered good candidates for this surgery.
Cytoredcution with HIPEC
The Cytoreductive surgery removes tumors from the abdomen, this is the only surgical option for patients with peritoneal mesothelioma. When paired with hyperthermic intraperitoneal chemotherapy (HIPEC), the surgery can increase a patient’s life expectancy. Patients diagnosed with peritoneal mesothelioma and who are in relatively good health are considered good candidates for this surgery.
CHEMOTHERAPY
Chemotherapy is an anti-cancer drug that kills fast-growing cancer cells. The following chemotherapy drugs, or a combinations of any of two of these drugs, may be prescribed to treat mesothelioma:
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Pemetrexed (Alimta®)
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Cisplatin
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Carboplatin
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Gemcitabine (Gemzar®)
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Methotrexate
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Vinorelbine
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Mitomycin
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Doxorubicin (Adriamycin®)
RADIATION
Radiation therapy may be used in all stages of cancer. It may be used following surgery to remove any remaining areas of cancer that were not seen or removed during surgery, this is referred to as adjuvant radiation therapy. Radiation therapy may be used as a palliative procedure to ease mesothelioma symptoms such as pain, shortness of breath, etc. There are only two types of radiation therapy are used to treat mesothelioma:
External beam radiation therapy (EBRT): This is the most common and effective. This radiation therapy uses x-rays from a machine outside the body to kill cancer cells.
Brachytherapy: For this kind of radiation therapy, which is rarely used for mesothelioma, a radiation source is put inside the body, in or near the cancer. Because the radiation travels only a very short distance, it minimizes any potential damage to nearby healthy tissues.
IMMUNOTHERAPY
Immunotherapy is an innovative approach that empowers the body's immune system to identify and combat cancer cells more effectively. In the context of mesothelioma immunotherapy has emerged as a promising treatment avenue, especially for cases where traditional treatments are insufficient.
Immune Checkpoint Inhibitors
A significant advancement in mesothelioma treatment involves immune checkpoint inhibitors. These drugs target specific proteins that ordinarily prevent immune cells from attacking healthy cells. By inhibiting these proteins, the immune response against cancer cells is enhanced.
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Nivolumab (Opdivo) and Ipilimumab (Yervoy): This combination was approved by the U.S. Food and Drug Administration (FDA) in October 2020 for the first-line treatment of adults with unresectable malignant pleural mesothelioma. Clinical trials demonstrated that patients receiving this combination experienced a median overall survival of 18.1 months, compared to 14.1 months for those undergoing standard chemotherapy.
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Pembrolizumab (Keytruda): In September 2024, the FDA approved pembrolizumab in combination with pemetrexed and platinum-based chemotherapy as a first-line treatment for unresectable advanced or metastatic malignant pleural mesothelioma. This approval was based on a Phase 3 trial where the combination therapy significantly improved overall survival, reducing the risk of death by 21% compared to chemotherapy alone.
Ongoing Research and Clinical Trials
The landscape of mesothelioma treatment is continually evolving, with numerous clinical trials investigating new immunotherapeutic strategies:
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Combination Therapies: Researchers are exploring the efficacy of combining immunotherapy drugs with traditional treatments like chemotherapy and radiation. These studies aim to determine if such combinations can enhance patient outcomes.
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Emerging Immunotherapies: Innovative treatments, including cancer vaccines and oncolytic viruses, are under investigation. These therapies seek to stimulate the immune system to recognize and attack mesothelioma cells more effectively.
For patients considering participation in clinical trials, it's essential to consult with healthcare providers to understand eligibility criteria and potential benefits. Clinical trials offer access to cutting-edge treatments that may not yet be widely available.
Side Effects and Considerations
Common Side Effects: Patients may experience fatigue, rash, nausea, decreased appetite, and musculoskeletal pain.
Immune-Related Adverse Events: Since immunotherapy enhances immune activity, there's a risk of the immune system attacking healthy organs, leading to conditions like pneumonitis, colitis, hepatitis, and endocrinopathies. Prompt reporting of new or worsening symptoms to healthcare providers is vital for timely management.