MESOTHELIOMA TREATMENT OPTIONS

While there is currently no known cure for malignant mesothelioma, treatments are available with the most common being surgery, chemotherapy and radiation therapy. Your doctor will recommend one treatment or a combination of therapies that are best for your situation. The course of treatment will depend on a number of factors including the location of the disease, the stage of the disease, your age, overall health and your preferences.

Questions & Answers about the Latest Treatments for Mesothelioma

The information provided throughout this website is for your information only, and should NOT take the place of a full medical diagnosis.

Traditional Treatment Options
There are three traditional kinds of treatment for patients with malignant mesothelioma:

• Surgery (physical removal of the cancer)
• Chemotherapy (using drugs to fight the cancer)
• Radiation Therapy (using high-dose x-rays to kill cancer cells)

Doctors will often use two or more of these treatment courses jointly to provide the maximum likelihood of success. This “multi-modal” approach holds the most promise for survival of malignant mesothelioma patients. Trimodality therapy, in which all three of these modalities are used, is considered the most effective, and aggressive, approach.

Surgery
There are several types of surgeries used to treat mesothelioma and the disease type and stage will determine the type of surgery. Mesothelioma tumors are usually large and difficult to completely remove, so surgery is usually combined with other cancer treatments to ensure the best results in destroying the tumor.

There are generally two types of surgical methods for the treatment of mesothelioma: Palliative Procedures and Potentially Curative Procedures.

• Palliative Procedures are those which treat the symptoms of mesothelioma, providing relief for the patient, without aggressively treating the disease itself.
  
  Chest Tube Drainage and Pleurodesis
  The goal of chemical pleurodesis is to cause an irritation between the two layers covering the lung. This irritation causes an obliteration of the space between the layers where the fluid accumulated, and prevents further fluid to be able to accumulate there. There are a variety of agents, which can be used including talc and bleomycin. As the pleural space is closed, fluid drains out of the chest cavity using a chest tube.
  
  Pleuroperitoneal Shunt
  Pleuroperitoneal shunting has been used in patients who have failed chemical pleurodesis, chemotherapy, or radiation therapy. Pleuroperitoneal shunting can provide effective palliation in patients with a trapped lung or others who have failed treatment.
   

• Potentially Curative Options are medical procedures that attempt to remove all gross disease with 'curative intent'. Residual microscopic disease cells are then removed through Adjuvant therapy.
  
  Pleurectomy/Decortication
  A Pleurectomy/Decortication is a surgical procedure where the pleura, the membrane lining the lungs and chest cavity, is removed, without removing the entire lung. This treatment option is usually performed on patients in the early staging of mesothelioma.
  
  Extra-Pleural Pneumonectomy (EPP)
  EPP is the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. EPP is considered a radical therapy and is not frequently performed by most surgeons, patients are referred to centers specializing in these treatments.
  
  Both the above 'potentially curative' procedures are typically used in combination with other treatment options (multi-modal therapy).
   

Chemotherapy
Chemotherapy uses drugs to kill cancer cells and may be used as the primary treatment to mesothelioma, or it may be used as part of a multi-modal approach. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle.

In addition to killing cancer cells, chemotherapy drugs work to restrict the uncontrolled spread of abnormal cancer cells - preventing them from dividing and multiplying.

Chemotherapy is not considered a 'curative' approach for the treatment of mesothelioma and instead focuses on shrinking existing tumors (usually prior to surgery - neoadjuvant therapy), controlling the spread of the cancerous cells, and removing residual cancer cells following surgery (adjuvant therapy).

To effectively treat mesothelioma, more than one drug may be used in chemotherapy. Depending on the drugs, the amount taken and the treatment period, there may be side effects. Historically, doxorubicin has been the most widely used single chemotherapy drug. Other newer drugs, including gemcitabine, cisplatin, carboplatin, epirubicin, cyclophosphamide, ifosfamide, vinorelbine, paclitaxel, and methotrexate, now are often preferred and are usually given in different combinations.

Radiation Therapy
Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation).

In pleural mesothelioma, it is difficult to irradiate tumor tissue successfully without injuring nearby organs like the lungs, heart, and liver. However, radiation therapy can be very effective in relieving pain in certain situations. Factors which can impact the use of radiation treatment include the volume of the tumor and how near it is to vital organs.

Non-Traditional Treatments

Photodynamic Therapy
Photodynamic therapy destroys cancer cells by using the energy from light and may also be effective when combined with surgery. Although this treatment is in the experimental stage for mesothelioma, it has shown promising results in treating other cancers. In the procedure, the patient receives a photosensitizer (a drug which makes cells sensitive to specific wavelengths of light) which collects in cancerous cells but not in healthy cells. Once the cells have been sensitized, fiber optic cables are placed in the body (usually through open-chest surgery) so that the correct frequency of light can be focused on the tumor. This causes the photosensitizer drug to produce a toxic oxygen molecule which kills the cancer cell.

Gene Therapy
This is a new treatment, currently in clinical trails. This approach allows treatment to target tumors, rather than destroying healthy cells which is the negative of traditional chemotherapy. In gene therapy, cancer is treated by altering genetic defects that allow a tumor to develop. A “suicide gene” is inserted directly into the tumor, making the cells sensitive to a normally ineffectual drug. The drug is then administered to the newly sensitive cancer cells and it destroys those cells while leaving the healthy cells unharmed.

Immunotherapy
Immunotherapy (or biological therapy) treats cancer by using the body’s own immune system fight cancer cells. Another name often applies to this therapy, biological response modifiers (BRMs). Though not yet obtainable, promising clinical studies are underway for immunotherapy.
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