Curative and palliative mesothelioma treatments may be combined to shrink or remove tumors and offer symptom relief. Curative care is generally available to patients with early-stage mesothelioma, whereas those in advanced stages may be candidates for palliative treatment options.
Factors Affecting Treatment
Treatment options vary on a case-by-case basis. Each patient will have unique driving factors that determine their course of treatment. The main factors affecting the treatment of mesothelioma are:
- Type of mesothelioma (pleural, peritoneal, or pericardial)
- Cell type present in mesothelial tumors (epithelioid, sarcomatoid, or biphasic)
- Stage or extent of the cancer’s spread (metastasis)
- Location and size of tumor(s)
- Patient age and overall health
Palliative Mesothelioma Treatments
In patients with advanced mesothelioma or elderly patients whose bodies are not strong enough to undergo invasive, potentially curative treatments, palliative care is often the only available option. This type of treatment is designed to relieve pain caused by the disease and its accompanying symptoms. Palliative procedures such as surgery, chemotherapy, and radiation may be used to slow the cancer’s growth and improve a patient’s quality of life.
Surgical procedures can be used curatively or palliatively. When possible, surgery is performed in an effort to remove the cancer in its entirety. Unfortunately, by stage 3 or 4, eradication becomes nearly impossible due to extensive spreading; however, surgery may still be performed to help with pain management.
Surgical options for pleural mesothelioma
There are two surgical options for early-stage pleural mesothelioma patients: pleurectomy with decortication, in which the linings of the lungs and chest are removed, along with any visible tumors; and extrapleural pneumonectomy, in which the entire affected lung is removed, along with the pleural linings of the chest and heart and a portion of the diaphragm.
Palliative treatment options for pleural mesothelioma help to decrease chest pain and make it easier for the patient to breathe.
Surgical options for peritoneal mesothelioma
Cytoreductive surgery is the most common curative treatment for peritoneal mesothelioma, as well as other abdominal cancers. During cytoreductive surgery, the surgeon will attempt to remove all of the visible tumors in the abdomen. Similar to pleural mesothelioma, paracentesis — the equivalent of thoracentesis — can be performed as a palliative treatment to remove built-up fluid in the abdomen.
Shunts are an additional palliative option used to manage fluid buildup. This procedure uses a tube with a pump to allow the fluid to move into a different area of the body where it may be better absorbed. While often associated with peritoneal mesothelioma, shunts may also be used for treating patients with persistent fluid buildup in the lungs and chest cavity.
Surgical options for pericardial mesothelioma
Because pericardial mesothelioma is so rare, there are few specialty treatments available. However, pericardiocentesis is the main palliative treatment option. This procedure uses a needle to remove fluid buildup around the heart. It can help relieve symptoms like chest pain and difficulty breathing. It may be followed by chemotherapy to provide further pain relief and management. Radiation is not typically used to treat pericardial mesothelioma, as it can cause damage to the heart.
Oncologists often use a combination of chemotherapy, or anti-cancer drugs, to treat mesothelioma. It can be used as a standalone treatment or in conjunction with other forms of curative and palliative care. Though chemotherapy may be used as a curative treatment, it can also help patients with advanced mesotheliomas keep the tumor from growing and causing additional pain.
Chemotherapy drugs commonly used to treat mesothelioma include:
- ALIMTA®, the trade name for pemetrexed, is the only chemotherapy drug approved by the Food and Drug Administration (FDA) for the treatment of mesothelioma and lung cancer. It is often used along with cisplatin for treating unresectable mesothelioma tumors (those that cannot be removed with surgery).
- Bevacizumab — branded as Avastin® — is another targeted chemotherapy drug used to treat mesothelioma, lung cancer, and ovarian cancer.
- Cisplatin, introduced in 1978, was the first drug of its kind. It has since been used to treat a number of different cancers, including mesothelioma. It is also known by the brand name Platinol®.
- Commended for its less severe side effects, Navelbine® (also known as vinorelbine) is a chemotherapy drug used to treat a number of different lung cancers.
Chemotherapy is given either in the form of pills or intravenously. In the case of mesothelioma, it can be administered through the chest (intrapleural) or the abdomen (intraperitoneal). Unlike radiation, chemotherapy attacks healthy cells as well as malignant cancer cells. This means that, though chemotherapy helps to keep the cancer and pain at bay, it takes a toll on the body. Common side effects include nausea, hair loss, weight loss, vomiting, and general fatigue. Doctors can usually work with patients to alleviate these additional symptoms.
Similar to other palliative options, radiation can be used alone or combined with surgery or chemotherapy. When following surgery, adjuvant radiation therapy has shown increased survival times, as it kills any remaining cancer cells not removed during the surgery.
A National Cancer Data Base (NCDB) study showed that patients who received surgery and radiation had a median survival of 21.4 months, compared to the 16.6-month average survival time seen in patients who only underwent surgery.
Radiation, sometimes called radiotherapy, is often used as a palliative form of care for patients who are in poor health and cannot undergo more intrusive treatments. It can be used to shrink tumors and alleviate pain caused by pressure in the lung or abdominal cavities. It is administered in two ways: externally or internally. These are known as external beam radiation therapy (EBRT) and brachytherapy, respectfully.
Common side effects mesothelioma patients may experience with radiation include fatigue, sunburn-like skin irritation, and localized hair loss. Prolonged chest radiation can cause damage to the lungs, resulting in difficulty breathing. Conversely, abdominal radiation may induce nausea or vomiting, diarrhea, and loss of appetite. The side effects associated with radiotherapy tend to be milder than those experienced with chemotherapy.
Clinical trials (experimental studies not yet approved by the FDA) offer some mesothelioma patients the hope of new treatment options and longer survival rates. The FDA requires clinical trials to complete three phases before they are approved as viable treatments. In phase 1, the clinical trial introduces a new drug and closely studies a small group of patients for side effects. If it is deemed safe, it is moved into phase 2. In this phase, the efficacy of the new treatment is monitored along with any dangerous side effects. If it is found to be effective and safe, it moves into phase 3. Unlike the first two phases, during phase 3 the drug is tested on a large population of closely monitored patients. The new drug is tested on a control group, and other participants receive drugs not included in the clinical trial. Researchers are then able to evaluate the effectiveness of the new drug.
While clinical trials involve a certain level of risk to patients, they have the potential to be very beneficial. Especially with a rare cancer such as mesothelioma, clinical trials can lead to major breakthroughs and better treatment options for patients in the future.
Visit ClinicalTrials.gov for an active list of mesothelioma clinical trials, as well as more information on recruiting, progress, locations, and more. Speak with your doctor to find out if qualifying trials may be the right course of treatment for you.
While a healthy lifestyle won’t cure your cancer, it can help strengthen your body, making it more receptive to treatment. Healthy changes that can significantly improve your well-being while living with mesothelioma include:
- Refraining from smoking
- Exercising regularly (without overexerting yourself)
- Eating a healthy diet
- Avoiding alcohol
- Getting plenty of rest