Mesothelioma Treatment Options
Mesothelioma patients are living longer and healthier lives than ever before thanks to new treatments. Some people have survived for 10, 15, and even 20 years or more with the disease. Doctors are hopeful that in the near future, mesothelioma will become a manageable chronic condition. While a cure remains elusive, mesothelioma is not the death sentence it once was. There are reasons to have hope.
Mesothelioma Help Center provides information about mesothelioma diagnosis, treatment, and financial and legal assistance. On this site you can learn about asbestos exposure and the different types of mesothelioma, connect with local mesothelioma medical experts, and find ways to pay for treatment.
The type of mesothelioma you have, the stage of the disease, your overall health, and other factors unique to each patient will determine the type(s) of treatment that you are eligible for. Receiving treatment from a specialized mesothelioma doctor at a top cancer center ensures that you will have access to the best and latest care.
We understand that treating cancer is expensive. You shouldn’t have to choose between your finances and your health. Many types of services, benefits, and compensation are available to mesothelioma patients. You are not alone in your fight against mesothelioma. We can help.
Pleural Mesothelioma Treatment
Pleural mesothelioma is typically treated with a combination of surgery, radiation therapy, and/or chemotherapy. Combining multiple treatments is known as multimodal therapy. Patients may also participate in a clinical trial that offers new, innovative therapies such as immunotherapy.
Treatment options depend upon individual circumstances such as the stage of the cancer and whether the patient is healthy enough for a specific course of treatment. Treatment can aim to eliminate as much of the cancer as possible in hopes of making the patient cancer free (curative), or to ease symptoms and control cancer growth (palliative).
Surgical options for pleural mesothelioma include:
- Pleurectomy/decortication: This procedure removes the pleural lung lining and all visible cancer but spares the underlying lung.
- Extrapleural Pneumonectomy: The most extensive surgery for pleural mesothelioma, extrapleural pneumonectomy removes all visible cancer, including the entire cancerous lung, part of the pericardium, part of the diaphragm, and part of the chest membrane.
- Pleurodesis: Pleurodesis is a procedure to remove and prevent fluid buildup between the inner and outer layers of the pleura. It is considered a palliative procedure.
Before a patient can undergo pleurectomy/decortication or extrapleural pneumonectomy, a series of tests is performed to determine if the patient is strong enough to tolerate the stresses of surgery.
Chemotherapy drugs kill cancer cells and stop them from spreading. Chemotherapy can be administered palliatively as a single modality treatment to patients unable to undergo surgery, or in combination with surgery. Chemotherapy given prior to surgery is known as neoadjuvant treatment. Adjuvant chemotherapy is given after surgery. Chemotherapy sometimes allows candidates who were previously not surgical candidates to undergo surgery.
Several different chemotherapy drugs are used to treat pleural mesothelioma. A single drug or a combination of drugs may be used. Inoperable mesothelioma is often treated with a combination of Alimta and Platinol. Systemic chemotherapy is taken by mouth or injected into a vein. Intrapleural chemotherapy is delivered directly to the pleural cavity. The drugs are sometimes heated before they are applied, a treatment called hyperthermic chemotherapy. When the treatment is given in the operating room right after surgery, it is known as heated intraoperative chemotherapy.
The effectiveness of chemotherapy for pleural mesothelioma varies from patient to patient. In the future doctors hope to use a patient’s genetic profile to select the most efficacious chemo drugs.
Radiation therapy uses high-energy rays to destroy cancer cells and decrease tumor size. It can be used to cure or control cancer or to relieve mesothelioma-related symptoms and improve quality of life.
Radiation has been shown to be a useful adjuvant (given after surgery) to extrapleural pneumonectomy. It is not usually given after pleurectomy/decortication due to possible lung complications. However, research is being done on different types of radiation, such as intensity modulated radiation therapy (IMRT) and photodynamic therapy, that might reduce damage to healthy tissue.
Radiation is given externally from a machine outside the body or internally using radioactive substances sealed in needles, seeds, wires, or catheters that are placed into or near the cancer.
Targeted therapy is a relatively new type of cancer treatment that uses drugs or other substances to directly attack cancer cells. Although technically a type of chemotherapy, targeted drugs work differently because unlike chemo drugs, they don’t affect all cells in the body. By specifically attacking cancer cells, targeted therapy typically cause less harm to healthy cells. A number of targeted drugs are used to treat mesothelioma.
Biologic therapy for mesothelioma, such as immunotherapy and gene therapy, is being studied in clinical trials. Clinical trials offer patients experimental treatments that aren’t yet available to the public. You can find mesothelioma clinical trials at ClinicalTrials.gov. Talk to your doctor to find out if you are a good candidate.
Peritoneal Mesothelioma Treatment
Without treatment, peritoneal mesothelioma patients might only live a year or less. But with treatment, patients can live for several years or longer. In fact, new treatment protocols have been shown to double the five-year survival rate for patients and increase median overall survival to nearly seven years.
But statistics do not account for outliers who live for many years with the disease. The longest documented peritoneal mesothelioma survivor was diagnosed with mesothelioma in 1997 and is still alive today.
As with other cancers, peritoneal mesothelioma can be treated with a combination of surgery, chemotherapy, and radiation.
Peritoneal mesothelioma surgery can be potentially curative or palliative. The goal of curative surgery is remove as much of the cancer as possible and hopefully cure the patient. Palliative surgery is meant to remove some of the cancer in order to relieve symptoms and improve a patient’s quality of live. The type of surgery a patient receives often depends on the stage of their cancer and the patient’s health.
- Paracentisis is a palliative procedure to remove fluid from the abdominal cavity.
- During a peritonectomy, the surgeon attempts to remove the cancerous portions of the peritoneum (the lining of the abdominal cavity).
- Cytoreductive surgery, or debulking, is a complex procedure that can involve removing all or part of the peritoneum as well as parts of different organs, including the stomach, liver, intestines, pancreas, and spleen. Cytoreduction is a complex procedure than generally takes 10 to 12 hours.
- Cytoreduction with intraperitoneal chemotherapy: The primary standard of care for peritoneal mesothelioma is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC)—a heated solution of chemotherapy drugs applied directly to the patient’s abdominal cavity while the patient is under general anesthesia. Patients who receive cytoreductive surgery with HIPEC have a median survival time of roughly three to seven years. Some patients undergo a cytoreduction and intraperitoneal chemotherapy regimen more than once if their cancer shows signs of coming back.
In addition to intraperitoneal chemotherapy delivered during surgery, patients may also receive postsurgical intraperitoneal chemotherapy through a port implanted under the skin. Intraperitoneal chemotherapy delivered a few days after surgery is called early postoperative intraperitoneal chemotherapy (EPIC). Normothermic intraperitoneal chemotherapy (NIPEC) is similar to EPIC but involves multiple treatment cycles. Research shows that these types of regional chemotherapy can extend a patient’s life.
Patients may also receive systemic chemotherapy (i.e. chemo drugs delivered via pills or intravenously) to shrink tumors and extend their life. Chemotherapy is sometimes used palliatively for peritoneal mesothelioma.
Radiation is not typically used to treat peritoneal mesothelioma because it could damage vital organs in the abdominal cavity. But radiation has proven useful for preventing malignant seeding in surgical incision sites.
While emerging treatments such as immunotherapy, gene therapy, and photodynamic therapy show promise for treating mesothelioma, much of the research has focused on pleural mesothelioma. Many experimental treatments are available through clinical trials.
Pericardial Mesothelioma Treatment
Pericardial mesothelioma has a grim prognosis. The average patient life expectancy after diagnosis is around six months. This is partly because of the difficulty of diagnosing this cancer and the resulting late stage diagnosis. Actual prognosis depends on tumor stage, disease pathology, and genetics.
With treatment, prognosis can improve. In one documented case a patient lived disease-free for 24 months after treatment. A mortality benefit has been seen in patients undergoing surgery and receiving chemotherapy. Patients may opt for a palliative treatment that relieves symptoms and improves quality of life.
- Pericardiectomy—removal of all or a portion of the pericardium—might help cure tumors, but the mesothelioma can rarely be entirely removed. Pericardiectomy is also used palliatively.
- Tumor resection (tumor removal) without removing the pericardium is possible.
- Pericardiocentesis is a palliative procedure done to remove fluid from the pericardium.
Chemotherapy for pericardial mesothelioma may reduce tumor mass. Combined chemotherapy—in particular pemetrexed and platinum-based drugs such as cisplatin—has been shown to produce a mortality benefit. One patient who was treated with cisplatin, gemcitabine, and vinorelbine remained disease-free for two years after chemotherapy. Chemotherapy is often combined with surgery to treat pericardial mesothelioma.
In general, pericardial mesothelioma has been shown to respond poorly to radiation therapy, but radiotherapy may be combined with surgery and chemotherapy. There is a case report of a patient having a prolonged positive clinical response following high dose radiation. A review of pericardial mesothelioma treatment found that 8 percent of patients received radiation, but there was no mortality benefit.
The low incidence of pericardial mesothelioma and small number of cases mean that little specific research has been done on treating this type of cancer. There is hope, however, that emerging mesothelioma treatments such as immunotherapy, gene therapy, anti-angiogenesis drugs, and photodynamic therapy will provide future treatment options for pericardial mesothelioma.
Help for Mesothelioma Patients
Mesothelioma survival rates are improving due to new treatments and better treatment protocols. But statistics don’t tell the whole story. Many patients have beaten the odds and lived with mesothelioma for many years. With the right treatment, you could do the same.