Multimodal treatment of mesothelioma

Doctors specializing in mesothelioma treatment frequently adopt a multimodal approach: they treat a patient with a combination of therapies. Due to the relative lack of effectiveness of single-modality treatment in affecting patient survival, the multimodal combination of treatments holds more promise for survival of malignant mesothelioma patients. For an over view of single-mode and multimodal treatment regimens, see the abstract of "Treatment of Malignant Mesothelioma" by M.T. Jaklitsch, S.C. Grondin, and D.J. Sugarbaker and published in the World Journal of Surgery in 2001.

The December 1999 issue of the medical journal, Chest, published a clinical case presentation that illustrates a fairly typical multimodal treatment. The patient was a 52-year-old man with an early diagnosis of Stage I pleural mesothelioma. Doctors performed a pleurectomy (i.e. surgery) and then delivered intrapleural doses of chemotherapy drugs. Then he received additional localized radiation and chemotherapy. Two years after the surgery he did not show evidence of the tumor.

The author concluded that "Aggressive trimodality therapy for mesothelioma is presented as a successful treatment option." (R. Buono - "Mesothelioma Clinical Presentation", Chest 1999; 116:444S-445S).

In recent years, there has been some progress made in the management of malignant mesothelioma, particularly in the area of combination of agents and treatment methods used. More details can be found in this interview with mesothelioma medical expert, Dr. Nicholas Vogelzang: "New Directions for the Treatment of Mesothelioma: An Expert Interview" (Oncology 6(1), 2003).

The following discussion of mesothelioma treatments is organized into separate sections (surgery, photodynamic therapy, radiation, etc.) so that each component of a combination of treatments (multimodality therapy) can be better understood.

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Mesothelioma Treatment Options - Surgery

There are two main types of surgical treatment for pleural mesothelioma: extra-pleural pneumonectomy (EPP) and pleurectomy/decortication.

EPP involves the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. Pleurectomy/decortication involves the removal of the pleura without removing the entire lung.

Which treatment is recommended depends on many factors, including the stage of the tumor. (The NCI has a detailed description of mesothelioma stages.) However, it is unclear if EPP provides significantly greater benefits than pleurectomy/decortication, and indeed if either is significantly more effective than non-surgical options.

A recent study followed about 400 mesothelioma patients who, between 1983 and 1998, had pleurectomy/decortication, or extra-pleural pneumonectomy (EPP), or thoracotomy. The results indicate that no one type of surgery was more effective than another in extending the survival rate. Rather, other factors seemed to determine how long people survived. These factors included the stage and cell type of the tumor, the gender of the patient, and the type of treatment(s) given together with the surgery. Click here for the text of this study.

Surgery can provide symptomatic relief and sometimes the bulk of the tumor can be removed. Surgery is often used in combination with other treatments (known as multi-modal treatments), but its value is very limited if the tumor is near any vital organs.

Both EPP and pleurectomy/decortication are complex surgeries, not performed frequently by most surgeons. They require referral to centers dedicated to such treatments. Many of these centers also specialize in other forms of mesothelioma treatment, either alone or in combination (multi-modal therapy.) You should discuss referrals with your doctor. See also: "The effect of extent of local resection on patients on patterns of disease progression in malignant pleural mesothelioma," by D.J. Stewart, et al in Ann.

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Mesothelioma Treatment Options - Radiation Therapy

This treatment involves the localized use of high-dose radiation (like x-rays) on malignant tumors. Usually, it is not a primary treatment but is used in conjunction with other therapies such as surgical resection and chemotherapy. It is generally used to reduce the size of the symptomatic tumor and help relieve symptoms like pain and shortness of breath.

Factors which can limit the application of this treatment include the volume of the tumor and how near it is to vital organs.

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Mesothelioma Chemotherapy

The term "chemotherapy" may be used to describe any drugs used in the treatment of disease but the word is commonly used to refer to medications utilized in the treatment of cancer. The term refers to treating disease with chemicals that kill cells. .

Generally, chemotherapy drugs work by targeting specific processes in cells that are undergoing rapid division and growth, preventing cell division, resulting in the death of the cancerous cells. Unfortunately, these drugs are not highly specific, and in addition to killing cancerous cells, chemotherapeutic drugs also kill healthy cells, such as those involved in hair growth.

In terms of mesothelioma treatment, several options for chemotherapy are available. Most chemotherapy drugs have specific side effects such as nausea, vomiting, loss of appetite, hair loss, and increased vulnerability to infection. Any symptoms experienced while undergoing treatment with chemotherapeutic drugs should be reported to the doctor.

Many mesothelioma patients will consider chemotherapy as a treatment option. Understanding the various chemotherapy options and available treatments often helps patients and their loved ones make the best decision for their personal situation. We offer a comprehensive packet detailing treatment and chemotherapy options and information about the side effects of the treatment, providing patients and family members with the most current information available. Click here to receive this packet overnight.

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Evaluating Chemotherapy Options

Deciding which chemotherapy option is the best treatment for specific mesothelioma cases depends on a number of factors, including the type of mesothelioma, the stage of the disease, and other treatment being administered. Factors such as overall physical health and age are also taken into consideration when detailing a chemotherapy treatment plan.

Currently more than 100 chemotherapy drugs are on the market but only a handful are deemed appropriate for fighting mesothelioma. In most cases, doctors treating mesothelioma patients recommend combination therapy - the tandem use of two different chemotherapy drugs. These combinations have been proven to be the most successful in the fight against mesothelioma. .

All treatment options will be thoroughly discussed with the patient's cancer doctor before a decision is made. Patients should provide a full disclosure of their medical history, including details of any prescriptions and over-the-counter medications being taken to ensure treatment is administered with the most appropriate chemotherapeutic agent.

Currently, the most common chemotherapy drugs for mesothelioma include Alimta (the only FDA-approved drug specifically designed for the treatment of mesothelioma), Cisplatin, Carboplatin, Onconase, Gemcitabine, and Navelbine. The medications are usually administered conventionally (by IV or pill form), or may be used in a newer treatment method called heated chemotherapy.

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Can Chemotherapy Cure Mesothelioma?

Currently, there is no proven cure for mesothelioma. However, chemotherapy can help control symptoms and shrink tumors and is largely used as a palliative measure to help improve the patient's quality of life. The development of combination treatments has proved successful in achieving longer survival rates and researchers continue to look for new ways to fight this aggressive disease.

If you or a loved one have been diagnosed with mesothelioma, you may find solace in reading “Lean on Me – Cancer through a Carer’s Eyes,” a touching story by Lorraine Kember who recounts her husband’s journey with mesothelioma in this emotional and informative book. For your complimentary copy, please use this form or visit the “Support Book” link to the right for more information.

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Other Treatments - Photodynamic, Gene, & Immunotherapy

Traditional cancer treatments such as radiation and chemotherapy may be more widely used to treat mesothelioma, but alternative therapies and treatments are on the rise.

To date, few cases of mesothelioma have been cured, and it is this fact that motivates the trend toward unconventional forms of therapy. It is the hope of countless mesothelioma patients and medical professionals across the globe that other therapies will one day afford a cure for this rapacious disease.

Alternative therapies such as gene therapy, immunotherapy, and photodynamic therapy are showing promising results and may one day be considered conventional forms of mesothelioma treatment.

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Gene Therapy

Gene therapy aims to correct the issues caused by a defective gene by using special techniques to replace the defective copy of a gene with a copy that functions properly.

The process is performed by genetically altering a virus to carry a normal copy of the gene. The patient is 'infected' with the virus, which enters target cells and causes them to produce normal proteins. Concerning mesothelioma treatment, this therapy uses genetic material to target cancer cells to make them susceptible to chemotherapy drugs.

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Immunotherapy

Immunotherapy is another form of alternative therapy that involves the use and manipulation of an individual's immune system to assist in the fighting of disease. When applied to mesothelioma and other forms of cancer, immunotherapy fools the immune system into registering cancer cells as foreign. This directs the immune system to destroy cancer cells, while leaving normal and healthy cells undisturbed.

Active immunotherapy treatments generally encourage the immune system to fight disease. Vaccines are considered an active type of immunotherapy. Conversely, passive immunotherapy treatments use components that are created outside the body. Non-specific immunotherapy treatments are different from active and passive in that they do not involve the use of cancer cells from the patient.

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Photodynamic Therapy

Photodynamic therapy works off the principle that normal cells and cancer cells react differently to photosensitizing drugs. This form of therapy utilizes light energy to obliterate cancer cells with the aim of leaving healthy cells mostly unaffected.

This process works by administering drugs called photosensitizers. These drugs cause cells to become sensitive to light. Upon receiving medication, treated cells are exposed to light of a particular wavelength. This causes the treated cells to produce a specific form of oxygen that is toxic to the cell, which results in the death of nearby cancer cells.