Mesothelioma - Treatment

Mesothelioma Treatment Options

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. While there is currently no cure available for malignant mesothelioma, there are treatments available. The types of treatments may include:

Surgery

Surgery is commonly used in the treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Sometimes this includes removal of the lung, the lining of the lung, the lining of the heart, and the muscle that helps us breathe. Generally, surgery for mesothelioma treatment is followed by chemotherapy and radiation. Surgery is usually combined with chemotherapy or radiation. The following are some of the most commonly used surgical treatments of mesothelioma:

Pleuro Mesothelioma Surgeries

Pleurodesis is a treatment administered through a thoracoscopy or existing chest tube. A tube is placed in the chest in order to drain out the fluid. The elimination of this space then inhibits the accumulation of a pleural effusion.

Surgery to remove part of the chest or abdomen lining (pleura) and some of the tissue surrounding it.

It is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.

A pneumonectomy is the removal of all or part of the lung. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.

Surgery to remove the pleura, diaphragm, pericardium, and entire lung involved with the tumor. Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself.

Peritoneal Mesothelioma Surgeries

Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen.

A “peritonectomy” involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease.

During cytoreductive or debulking surgery, the surgeon opens the abdominal to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be quite long in duration because of the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area.

Radiation therapy

Radiation: involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. Radiation causes the fewest side effects and is usually easier to tolerate than chemo. There are a few different forms of radiation therapy available to meso patients:

In one study, doctors at Sloan Kettering Memorial Hospital in New York reported that treating mesothelioma patients through surgical lung removal plus high dose radiation increased their median survival by about 5 months.

The most common side effect from radiotherapy is fatigue or tiredness. Patients often feel fatigue towards the end of the course of radiotherapy. Some people get skin rashes or skin irritation around the radiotherapy area. Pleural mesothelioma patients may develop a cough or have difficulty swallowing after radiotherapy treatment.

Chemotherapy

Using drugs to kill cancer cells. Chemotherapy can be given to patients who are not surgical candidates. Chemotherapy alone cannot cure mesothelioma but can prolong life. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Pemetrexed is the first chemotherapy drug approved to specifically treat pleural mesothelioma. It has prolonged patients’ survival and improved the quality of their lives. New drugs such as raltitrexed and ranpirnase are still in the experimental stage.

Raltitrexed (Tomudex®)

Raltitrexed works by interfering with the ability of tumor cells to multiply and make deoxyribonucleic acid or DNA. One early–stage clinical study showed a positive response rate in mesothelioma patients of about 20% when raltitrexed was used alone

Ranpirnase or P–30 Protein (Onconase®)

A ribonuclease isolated from the eggs of the leopard frog, Onconase® interrupts protein synthesis and inhibits cancer cell growth. In a limited study of 105 patients treated with Onconase®, the one–year and two–year survival rates were 34.3% and 21.6 %. This compares well with the usual survival rate of 6 to 8 months without treatment.

At Brigham and Women’s Hospital in Boston, some patients with mesothelioma are treated with a combination of extrapleural pneumonectomy, radiotherapy, and chemotherapy. Various studies showed patients with an increase in median survival rate of 9 months to a year in some cases. In Scotland, a recent study of 191 mesothelioma patients treated with extrapleural pneumonectomy and chemotherapy gave promising results. They had a mean survival time of 35 months, compared to a survival time of 9 months for patients treated with palliative or pain–reducing care only.

NEW MESOTHELIOMA TREATMENT APPROACHES

Intraoperative photodynamic therapy

A new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.

This new approach uses the body's own immune system to fight the cancer within the body. Immunotherapy treatments are currently being evaluated in clinical trials. Immunotherapy is in the experimental stage, especially for mesothelioma patients. Some research has not gone beyond the laboratory, using human and animal mesothelioma cell lines.

Gene therapy

Gene therapy means inserting specific genes into cells to change or restore their functions. This approach is designed to treat mesothelioma by correcting the genes that allow a cancerous tumor to grow, potentially controlling tumor size and spread. Like immunotherapy, gene therapy clinical trials are currently underway.

Photodynamic therapy or PDT uses laser light to kill cancer cells.

The patient receives a photosensitizing agent, which is a drug that makes the cancer cells vulnerable and sensitive to light of specific wavelengths. The photosensitizer collects in the cancerous cells. After the cancer cells have been sensitized, fiber–optic cables are placed in the body in order to focus light of just the right frequency on the tumor. This causes the photosensitizer to react with oxygen to produce a toxic molecule that kills the cancer cell.

Photodynamic therapy has been used on an experimental basis during surgery to help prevent the recurrence of mesothelioma cancer in the lining of the lungs or pleura.

Intensity-modulated radiation therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is a novel breakthrough in radiation oncology. It allows treatment of areas that were previously out of the reach of conventional radiation. The state of the art machinery available represents the top-of the line in radiation delivery equipment. Preliminary data indicates significant improvements in local recurrences for mesothelioma patients undergoing this treatment.

Alternative medicine

Alternative medicine is defined as therapeutic practices, which are not currently considered an integral part of conventional medical practice. Alternative therapies include, but are not limited to the following disciplines: folk medicine, herbal medicine, diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, massage, and music therapy.

New Drugs

These include anti-angiogenesis drugs (which kill cancers by stopping their blood supply) such as Bevacizumab (Avastin) and anti-growth factor drugs (which interfere with substances some cancer cells produce to stimulate their own growth) such as Erlotinib (Tarceva).

www.cancer.org

Mesothelioma Research - Table of Contents

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