Malignant mesothelioma is most treatable during the early stages (stages 1 and 2) when patients often have multiple curative options.
Advanced stage patients (stages 3 and 4) have fewer mesothelioma treatment options. During these stages, doctors mainly focus on improving a patient’s quality of life through palliative care.
Mesothelioma specialists create personalized treatment plans for each patient. To come up with the best treatment option(s) for a patient, doctors consider everything from a patient’s health to their cancer cell type to their personal wishes.
Standard mesothelioma treatment falls into 3 main categories:
Depending on the individual patient, doctors will recommend different treatment options and combinations.
Surgery for mesothelioma involves removing the malignant tumor(s) and the surrounding tissue and organs — either partially or fully — to stop the spread of cancer. Surgery is often the most effective way to increase the lifespan of mesothelioma patients, but it is usually recommended for early-stage patients only.
Mesothelioma specialists have developed one or two types of standard surgeries for the different types of mesothelioma.
Most Common Mesothelioma Surgeries
||Extrapleural pneumonectomy (EPP)
||Removal of the diseased lung and pleura
||Pleurectomy with decortication (P/D)
||Removal of the diseased pleura and any visible tumors
||Cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC)
||Removal of all visible cancer in the abdomen followed by the direct application of chemotherapy drugs into the abdomen
||The removal of tumors by removing part or all of the lining of the heart
Doctors often use chemotherapy and radiation along with surgery to achieve the best curative results.
During chemotherapy for mesothelioma, doctors introduce cancer-fighting drugs into a patient’s system. For mesothelioma, chemotherapy alone is generally considered only if surgery is not a treatment option. However, chemotherapy is typically combined with surgery to remove as much of the cancer as possible.
Chemotherapy for mesothelioma may be used to:
- Kill remaining cancer cells after surgery
- Reduce tumor size
- Slow the spread of mesothelioma
- Treat patients who cannot undergo surgery
Standard chemotherapy is administered in cycles over the course of several weeks or months. Chemotherapy may also be directly applied to the abdominal cavity during HIPEC for peritoneal mesothelioma.
Chemotherapy is known to have serious side effects such as vomiting, hair loss, and kidney damage, but milder variations of some approved drug combinations exist. Researchers are searching for ways to improve the effectiveness of chemotherapy while reducing its side effects.
During mesothelioma radiation therapy, doctors use focused high-energy radiation beams aimed directly at the tumor site to shrink the tumors. These beams affect mesothelioma cells by interfering with their DNA, preventing them from multiplying and spreading.
Radiation therapy has few side effects compared to chemotherapy, and it is often used as palliative treatment for late-stage mesothelioma patients.
It is also commonly used alongside chemotherapy and surgery to help extend the life of patients as much as possible.
Doctors usually prescribe more than one type of mesothelioma treatment, especially for early-stage mesothelioma patients. Using this multimodal approach, doctors can destroy as much of the cancer as possible.
Specialists may recommend an initial radiation treatment to shrink tumors before surgically removing them. Doctors may also surgically remove the tumor first and then use radiation or chemotherapy to destroy remaining cancer cells.
Many researchers and organizations, such as the American Society of Clinical Oncology (ASCO), have found that a multimodal approach is more effective in treating mesothelioma than any one treatment alone.
The ASCO’s clinical practice guideline for pleural mesothelioma reported that for pleural mesothelioma patients able to undergo their entire multimodal treatment plan, median overall survival was 21-59 months. This is far longer than the 12-month survival time of late-stage patients who could not undergo surgery.
Stage 3 and 4 mesothelioma patients are often unable to get curative treatments. However, doctors can still prescribe palliative treatments to help reduce their pain and discomfort.
Palliative treatment options include:
- Chemotherapy: Chemotherapy can shrink tumors, relieving symptoms of late-stage mesothelioma. While chemotherapy may cause serious side effects, new medical interventions may help reduce them.
- Radiation: Radiation may also help reduce tumor size, easing symptoms. In addition, radiation often has fewer side effects than chemotherapy.
- Low-risk surgeries: Minor surgeries such as thoracentesis and catheter insertion may be performed to drain extra fluid in the organs or make the process easier, reducing symptoms.
- Alternative therapies: Non-medical techniques such as massage, meditation, and acupuncture may help some patients manage pain and stress.
As it grows and spreads, malignant mesothelioma can gravely decrease a patient’s quality of life, making palliative care an essential part of treatment.
Clinical trials are experiments or observations conducted to improve current treatment methods for a disease.
While they are not guaranteed to be effective, mesothelioma clinical trials offer hope to patients without standard treatment options and contribute vital information to future mesothelioma treatment efforts.
Other Mesothelioma Treatment Options
Several promising new cancer treatments are currently being developed. Mesothelioma patients may be able to access these cutting edge treatments through clinical trials.
Some promising mesothelioma treatment options include:
- Anti-angiogenesis: Anti-angiogenesis blocks blood vessel growth in cancerous tumors, which need extra blood in order to grow. This treatment may stop cancer in its tracks by preventing it from spreading beyond a few millimeters.
- Chemotherapy advancements: In the future, doctors may regularly administer chemotherapy drugs capable of targeting specific molecules that help cancer cells grow and spread.
- Gene therapy: Gene therapy may be used in several ways to fight cancer. One potential method involves injecting a patient’s cancer cells with new genes that slow or stop growth.
- Immunotherapy: Immunotherapy fights cancer by training a patient’s immune system to more effectively find and destroy cancer cells.
- Photodynamic therapy: Photodynamic therapy uses special drugs to make cancer cells vulnerable to high-intensity light. Once vulnerable, these cells can be destroyed with lasers or other light energy sources.
Medical professionals hope that these new treatments prove more effective at fighting cancer than current methods, are less harmful to patients, and, one day, lead to a cure.