What treatment options you are getting for mesothelioma depends on your general health and other aspects of your cancer, such as its location and staging.
Unfortunately, mesothelioma is an aggressive tumor, and a cure is not feasible for most people. It is typically diagnosed at an advanced stage — when cancer can not be removed by surgery. Instead, the doctor may be working to monitor cancer and make you more comfortable by easing your symptoms.
Speak to the doctor about recovery objectives. Some people try to do whatever they can to cure their cancer, even though it means long-lasting side effects with a slim chance of change. Others want therapies that make them symptom-free so they can spend their remaining life as comfortable as possible. Following are some of the most common treatment options for mesothelioma.
Surgeons work to eliminate mesothelioma cells and tissues when diagnosed at an early stage. This will cure cancer in some cases. However, most of the time, it’s not possible to kill all cancers. In this situation, surgical intervention is done to help reduce the signs and symptoms of mesothelioma. The common surgical options may include:
Surgery to decrease fluid buildup – Pleural mesothelioma leads to build-up of fluid in the chest, causing trouble breathing. To drain the fluid, the surgeons insert a tube or catheter into your chest. Doctors can also inject medications into the chest wall to reduce the inflammation and prevent the return of fluid (pleurodesis).
Removal of the tissue around the lungs – In this procedure, surgeons remove the tissue lining of the ribs and lungs. This treatment does not cure mesothelioma but can alleviate the troublesome signs and symptoms.
Remove of the lung and the surrounding tissue – Removal of the infected lung and tissue that surrounds it may alleviate signs and symptoms. This procedure is helpful if your tumor is localized to one lung and has not yet spread to the second lung or other parts of the body.
Surgical removal of peritoneal mesothelioma – Peritoneal mesothelioma is often treated with surgical removal of the peritoneum. Chemotherapy and radiotherapy can be used either before or after surgery to optimize the clinical outcome.
Chemotherapy uses chemical agents (drugs) to destroy cancer cells. Systemic (IV) chemotherapy spreads around the body and can minimize or slow down the development of mesothelioma that can not be removed by surgery. Chemotherapy is also used before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) to make surgery safer or to minimize the risk that cancer may return.
Chemotherapy medications may also be used as intraperitoneal chemotherapy in which these drugs are heated and delivered directly to the abdominal cavity.
Radiation therapy concentrates high-energy radiation from sources such as x-rays and protons to a particular location or area on the body. Radiation can be used to destroy any remaining cancer cells following surgery. This can also help to reduce the signs and symptoms of advanced cancer in cases where surgery is not a viable option.
Clinical Trials and Experimental Treatments
Researchers and clinicians continue to make strides in mesothelioma science, with attempts to find a definitive cure and more safe and effective treatment options. Until a treatment option is approved by the FDA and widely available to all patients, it is considered as experimental and is only given by clinical trials. Experimental therapies have the potential to replace current treatments and become a standard care choice if shown to be effective.
Patients with malignant mesothelioma must comply with certain requirements in order to be able to participate in a clinical trial. In most cases, new therapies are intended for patients who are at a late stage and/or who do not respond well to conventional treatment options. Emerging therapies may be able to increase the lifespan of patients. At the end of the day, patients will discuss their choices with their mesothelioma doctor to recognize eligibility.
Immunotherapy has been shown by several studies to be effective in the treatment of mesothelioma and other diseases. Used on its own or in combination with traditional therapies such as chemotherapy and radiotherapy, immunotherapy has shown encouraging results in the treatment of mesothelioma. It stimulates the immune system and is shown to improve life expectancy by months or even years.
Clinical trials are ongoing to test the effectiveness of various immunotherapy drugs. Most common types of immunotherapy include;
- Adoptive cell therapy
- Monoclonal antibodies
- Checkpoint inhibitors
- Cancer vaccines
Gene therapy is an emerging treatment option that has shown promising results in the treatment of malignant mesothelioma. This therapy works by restoring the genetic structure or function of the cells. If repair is effective, it can potentially cure the disease or help prevent the development of diseases. Interestingly, it doesn’t have as many side effects as therapies such as chemotherapy or radiation therapy. Gene therapy types include:
- Gene transfer
- Oncolytic viruses
- Genetic virotherapy
In a majority of cases, mesothelioma physicians may prescribe a multimodal approach that includes a combination of therapies such as surgery, chemotherapy, radiation therapy, and in some cases, new therapies. Multimodal treatment approach has been shown to be more effective in multiple trials than either of the individual treatment options alone. In particular, surgical removal of the cancerous tissues is combined with hyperthermic intraperitoneal chemotherapy (HIPEC). It is a technique in which heated chemotherapy is applied directly to the abdominal cavity. In recent clinical trials, it has shown approximately 50% or higher survival rates for peritoneal mesothelioma patients.
Physicians refer to treatments as neoadjuvant, primary or adjuvant when performing a multimodal care program. The three forms of treatment are calculated on the basis of the order in which they are administered. These include
- Neoadjuvant therapy: A therapy that is used before the primary treatment (e.g., surgery) to shrink or reduce tumor size.
- Primary treatment: It is the main type of treatment used to remove as much of the tumor tissues as possible. In most cases, surgery is the primary treatment option.
- Adjuvant therapy: It is the treatment performed after the primary treatment (surgery) to kill remaining cancer cells or to reduce the side effects of primary treatment.