Mesothelioma Treatment Options

Mesothelioma is an aggressive disease that requires an equally aggressive treatment strategy. Malignant mesothelioma is resistant to many standard cancer treatments, making it a difficult disease to manage and cure.

Approximately 3,000 Americans are diagnosed each year with mesothelioma, whose only known cause is asbestos exposure.

When you meet with a mesothelioma specialist about your diagnosis, the doctor will walk you through the traditional treatment options like chemotherapy, surgery, radiation, or a multi-modal approach.

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Table of Contents

Surgery
Radiation Therapy
Palliative Procedures
Clinical Trials
Immunotherapy
Photodynamic Therapy
Holistic & Alternative Treatments
Treatment Timeline

Treatment for the asbestos cancer mesothelioma is classified as one of two types — curative or palliative.

Curative therapy focuses on killing the cancer cells and stopping further growth.
Palliative care treatments aim at relieving the symptoms and improving the patient’s quality of life.

Regardless of the approach taken, the primary doctor will closely monitor the patient’s response to therapy and make any needed adjustments to the treatment plan.

In many instances, a patient will begin treatment with an aggressive protocol, but will be transitioned to a more palliative treatment plan if the disease stops responding to the aggressive therapies.

An empowered mesothelioma patient is often the best patient for a medical team. Empowered patients are informed of their disease’s track and treatment options, and they are willing to take an active role in their treatment strategies.

Knowing what questions to ask of your physician is an important step toward becoming an empowered mesothelioma patient.

Learning about the benefits and risks of each treatment option is critical to ensuring you are prepared for the arduous battle ahead. Listen closely to your doctor, and ask as many questions as you need to get the full picture.

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Treatment Information

Treatment Options

Traditional Treatments and Therapies

Surgery: Physical Removal of the Cancer

Mesothelioma surgery involves the physical removal of the cancer or other operative treatment.

There are several surgeries available for patients, some of which are used palliatively to treat symptoms and others of which are considered radical surgery, such as removal of one of the lungs, with curative intent.

The physician will decide the nature and type of surgery to be performed based on his or her overall treatment strategy and the information determined during the patient’s workup.

The most common radical surgeries for mesothelioma include:

Extrapleural Pneumonectomy (EPP), during which the surgeon removes the patient’s lung, the affected tissue, and surrounding lymph nodes
Pleurectomy Decortication (P/D), during which the surgeon removes the pleural tissue lining the lung and chest cavity, as well as the tissue lining the diaphragm and the mediastinum
Cytoreduction or debulking surgery, during which the surgeon removes any signs of cancer from the peritoneal/abdominal cavity and the patient receives heated interoperative chemotherapy at the same time

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Chemotherapy: Using Drugs to Fight the Cancer

Chemotherapy uses drugs and other chemicals to kill cancer cells.

Treatment with chemotherapy is considered “systemic treatment” because drugs are introduced via the bloodstream and kill cancer cells throughout the body.

The most common chemotherapy drugs for mesothelioma are pemetrexed and a combination of gemcitabine and cisplatin.

However, your doctor may recommend a variety of combinations of other chemotherapy drugs.

Chemotherapy comes with harsh side effects:

Flu-like symptoms
Fever
Fatigue
Nausea and vomiting
Constipation
Poor appetite
Shortness of breath
Chest pain
Taste changes
Hair loss
Weakness
Blood test abnormalities
Low white blood cell count
Low red blood cell count

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Radiation Therapy

Radiation therapy uses ionizing radiation to destroy cancer cells and shrink tumors.

Radiation can be used as part of a multimodal treatment protocol, or it can be used in a palliative manner to reduce the pain associated with the disease.

Recent advances in understanding mesothelioma’s complex biology have led to improvements in the effectiveness of the standard therapies.

Those advances are reflected in an increase in median survival times reported by some patients. Much more research needs to be done before the medical community can say it has turned a corner in the treatment of mesothelioma.

Even so, the increase in survival times in patients treated with an effective multimodal protocol points to a new level of hope for mesothelioma patients.

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Palliative Procedures

Since there is no cure for malignant mesothelioma, many of the treatment options are considered palliative, aimed at making the patient more comfortable by easing symptoms.

Palliative procedures your doctor may consider include:

Pleurodesis, which is used to seal the pleural space so fluid cannot keep building up around the lungs
Pleurocentesis or thoracentesis, which is used to remove fluid buildup in the chest cavity
Paracentesis, which is used to remove ascetic fluid from the abdominal cavity
Pericardiocentesis, which is used to remove fluid buildup from the pericardial sac around the heart

Your doctor will devise a treatment plan based on your general health and the stage of your disease. (Some people are not healthy enough for surgery, for example.)

You should also ask about alternative treatments such as immunotherapy and clinical trials.

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Other Mesothelioma
Treatments

Every day, doctors and researchers around the world are continually searching for the next best treatment or the cure for mesothelioma and other cancers. For patients and families, there is hope on the horizon in these alternative treatments.

Some alternative treatments you may want to discuss with your doctor include:

Clinical Trials

Before new mesothelioma treatments make it to market, they are tested in clinical trials.

You should talk to your doctor about what clinical trials may be right for you, and try to talk to other patients who have participated in trials.

They can explain the process and give you an idea of what to expect.

Immunotherapy

Your immune system is designed to identify and attack dangerous cells and illnesses that invade your body.

Unfortunately, mesothelioma cancer cells tend to go undetected by the immune system, allowing them time to grow and spread.

Immunotherapy, sometimes referred to as biologic therapy or biotherapy, helps your own immune system fight the cancer. This can be done by either stimulating the immune system to attack the cancer cells or by blocking the cancer cells’ signals that allow them to hide from the immune system.

Photodynamic Therapy

Photodynamic therapy (PDT) uses a drug ─ known as a photosensitizing agent or photosensitizer ─ that is given intravenously, absorbed into the body, and then activated by a special light.

Once activated, the photosensitizing agent produces a kind of oxygen that destroys the surrounding cells, particularly cancer cells, with relatively mild side effects.

Although photodynamic therapy is not yet an FDA-approved treatment for mesothelioma, it is being studied as a potential option.

Holistic & Alternative Treatments

You may want to talk to your doctor about holistic treatment options, which aim to care for the patient as a “whole” rather than the specific symptoms or illness.

A holistic care approach would take into account your physical, psychological, and spiritual well-being. Acupuncture, homeopathic medicines, and hypnosis are all types of holistic treatments.

Step 1: Diagnostic Imaging Tests

When you first suspect that you are experiencing symptoms of mesothelioma or any other asbestos disease, you should speak with your doctor about your history of exposure to asbestos. Because mesothelioma is such a rare cancer, a doctor may not recognize the symptoms immediately or may mistake them for signs of other lung diseases.

Your doctor will likely start by discussing your work or service history, conducting a physical exam, and ordering imaging tests such as X-rays, CT scans, or MRIs.

Diagnosing malignant mesothelioma in an early stage can greatly increase a patient’s life expectancy. So it is crucial that you talk to your doctor as soon as you experience potential symptoms.

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Step 2: Biopsy

Your doctor will need to order a biopsy to make a mesothelioma diagnosis. This involves taking cells from the area affected and looking at them under a microscope.

Your doctor may consider the following:

Surgical biopsy to remove a large portion of or the entire mesothelioma tumor
Endoscopic biopsy, which uses a thin tube and a tiny camera to examine the tissue and take a sample
Needle biopsy to remove a piece of the tumor

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dr.-david-sugar-baker mesothelioma specialist

Step 3: Meeting with a Specialist

Because malignant mesothelioma is such a rare disease, you will need to meet with a specialist who has experience treating asbestos cancers.

There are specialized mesothelioma treatment centers throughout the United States, where medical experts can provide a comprehensive treatment plan.

A mesothelioma specialist also can help connect you with clinical trials and keep you updated on new treatments coming on the market.

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Step 4: Follow the Treatment Plan

Your medical team will tailor a treatment plan based on your specific needs and condition.

Most treatment plans involve a multimodal approach, combining several types of treatment to obtain the best results.

Be sure to give your doctors feedback on how you are feeling throughout the process. Your doctors may need to adjust your treatment plan as you go.

The costs associated with mesothelioma treatment can be devastating to a family.

In addition to the crushing medical expenses, caregivers may need to quit their jobs to devote their full attention to helping the patient.

Financial help is available for mesothelioma patients and their families.

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Sources

Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York. 2005.
De Perrot, M., Feld, R., Cho, B.C. J., Bezjak, A., Anraku, M., et al.. Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma.Retrieved from http://ascopubs.org/doi/abs/10.1200/jco.2008.17.5604?keytype2=tf_ipsecsha&ijkey=cc3963ea9a3a4bb5b4de2a5ed1215dfe6c125413
Munkholm-Larsen, S., Cao, C. Q., & Yan, T. D. (2009). Malignant pleural mesothelioma. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999110/
Stahel, R.A., Weder, W., Lievens, Y., & Felip, E. (2010). Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Retrieved from http://annonc.oxfordjournals.org/content/21/suppl_5/v126.long
U.S. Food and Drug Administration: FDA approves new treatment for a type of late-stage lung cancer
Drugs.com: Verastem Initiates Registration-Directed Trial of Defactinib in Patients with Mesothelioma
Business Wire: Verastem Reports Data from Phase 1 Study of VS-6063 (defactinib) in Japanese Patients