Why Mesothelioma Treatment Isn’t a “One-Size-Fits-All” Solution

Many diseases have a one-size-fits-all treatment plan. For instance, if you have strep throat, you’ll be treated with amoxicillin. Mesothelioma treatment is not like that. There are many different treatment options, and each treatment plan is tailored to the individual.

The reason mesothelioma doesn’t respond well to one type of solution is that the disease itself is so diverse. There are three main locations where mesothelioma forms: pleural (lungs), peritoneal (abdomen) and pericardial (heart). Furthermore, there are three distinct cell types of mesothelioma: epithelioid, sarcomatoid and biphasic or mixed.

Other factors that play into what type of mesothelioma treatment will work best for patients include:

  • Overall patient health
  • Mesothelioma disease stage
  • Whether or not the tumor is resectable or removable
  • How much the mesothelioma has spread (metastasis)

Many other factors come into play when looking at what treatments are likely to be most effective, including the patient’s genetics.

How These Factors Can Impact Treatments

One example of how the different factors can influence the treatment type chosen is from a study by Dr. Friedberg his colleagues. In this study, they looked at the effectiveness of extended pleurectomy and decortication (EPD) with intraoperative photodynamic therapy (PDT)—that is the PDT was administered during the operation—and adjuvant or postoperative pemetrexed-based chemotherapy on patients with epithelioid mesothelioma.

They determined that trimodal therapy was effective for patients with epithelioid cell type. However, after the surgeries, Dr. Friedberg and his team discovered that some of the test subjects had biphasic mesothelioma. These individuals did not see the same benefit as those with the epithelioid cell type.

Another example would be chemotherapy. While chemotherapy is often one of the standard therapies offered for patients with mesothelioma, it is only effective between 35 and 41% of the time. This means that the majority of mesothelioma patients who receive chemotherapy will not get any benefits from it. In these cases, the patient’s care team will need to look into other options. These options might include radiation therapy, immunotherapy or targeted therapies.

Emerging Therapies Impact on Individualization

Right now there is a lot of research into immunotherapy and targeted therapy. As the research around them grows, improves and creates more treatment options, how mesothelioma is treated will become even more diverse.

Immunotherapy works with the body to help it kill off the cancer cells on its own. These programs can help individualize mesothelioma treatment further because they can be used in cases where chemotherapy has failed to support the patient’s immune system mobilize and defend itself. Furthermore, in some cases where a patient’s cancer is deemed inoperable, immunotherapy can still be used as a treatment.

Targeted therapy focuses on fighting mesothelioma at a molecular level. One way that targeted therapy will help further individualize treatment plans is that it focuses on a person’s and cancers genetics. This can help doctors determine which treatment plans will be most useful for that individual. Sometimes the reason cancer treatments fail to work is that the body lacks specific proteins and produces more of others. When doctors can rebalance those proteins, it can enable more traditional therapies, such as radiation therapy, to be more effective.