Mesothelioma Treatment

Malignant mesothelioma treatment is individualized for each patient. The treatment plan may be focused on extending life through treatments like surgery, chemotherapy, immunotherapy, and radiation therapy. Although the cancer is currently considered incurable, this multimodality treatment can significantly extend life for some patients. Some patients are treated with palliative care, which focuses on quality of life rather than length of life.

Life-Extending Treatment for Mesothelioma

Mesothelioma is currently considered to be incurable because it’s rare for patients to go into long-term remission. However, this doesn’t mean that there are no effective ways to treat this disease. Treatments can significantly extend life for some patients.

Tumor-removing surgery

This type of surgery aims to remove as much of the cancer as possible. Surgical options may include:

  • Extrapleural pneumonectomy (EPP). This is the most invasive procedure used for pleural mesothelioma and involves removing the pleura (the membrane around the lung) along with the lung itself and other tissues on the affected side.
  • Pleurectomy/decortication (P/D). This is a less invasive procedure that can be used for pleural mesothelioma patients, and removes the pleura but not the lung. The thoracic surgeon removes as much visible tumor tissue as possible, while minimizing the removal of healthy tissues.
  • Cytoreductive surgery (CRS), which is the mainstay of treatment for peritoneal mesothelioma. The surgeon removes a large part of the peritoneum (the membrane around the digestive system), along with any visible tumor tissue in the abdominal cavity. This may require removing parts of the intestine, the gallbladder, the spleen, and other organs.

To be candidates for tumor-removing surgery, patients usually need to be in a relatively early stage of cancer. Patients who have the sarcomatoid cell type are generally not considered candidates, as studies have not shown a survival benefit for surgery in these patients. In addition, patients must be in good general health to consider surgery, as these are very invasive procedures.

Chemotherapy

There are various ways that chemotherapy may be used to treat mesothelioma. The most common chemotherapy drug combination used for mesothelioma is pemetrexed along with either cisplatin or carboplatin.

  • Adjuvant chemotherapy is given after surgery to target any cancer cells that were not removed during the procedure.
  • Neoadjuvant chemotherapy is given before surgery to help shrink the tumor to make it easier to remove.
  • Intraoperative chemotherapy is given during a surgical procedure. After removal of the tumor, a warmed solution of chemotherapy drugs is infused into the body, left there for a period of time, and then washed out.
    • Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with CRS is the standard treatment for peritoneal mesothelioma in eligible patients. When combined with CRS, 5-year survival rates have been reported to be as high as 44%.
    • More recently, hyperthermic intrathoracic chemotherapy (HITHOC) has been used successfully in pleural mesothelioma.
  • Standalone chemotherapy. Chemotherapy doesn’t have to be combined with surgery. Some patients receive chemotherapy on its own. For those who aren’t candidates for surgery, chemotherapy is generally the mainstay of treatment in both pleural and peritoneal mesothelioma.

Radiation therapy

After surgery, radiotherapy may be used to target cancer cells that may have been left behind. It can also be used in those who aren’t eligible for surgery. The most common type is external beam radiation therapy (EBRT), which targets cancer cells using X-rays. Multiple weaker beams of X-ray radiation are aimed at the tumor from different angles. At the site of the tumor, the beams cross, delivering a significant dose of radiation to that area. Other areas receive far less radiation, which reduces side effects. Other types of radiation therapy exist, but are rarely used for mesothelioma.

Immunotherapy

Immunotherapy is a treatment modality that uses the body’s own immune system to destroy cancer cells. The FDA has approved two immunotherapy treatments (Keytruda, and Opdivo plus Yervoy) for use in certain mesothelioma patients. Cancer cells may alter the function of certain proteins in order to evade the immune system; these immunotherapy agents restore normal function of these proteins, in order to allow the immune system to target the mesothelioma cells.

Tumor-Treating Fields (TTF)

This is one of the newest treatment options and was FDA-approved in 2019 for the treatment of patients with unresectable malignant pleural mesothelioma. It uses alternating electrical currents passed through the skin to disrupt the ability of the cancer cells to divide and grow, and is approved for use in combination with chemotherapy. Use of this device has been shown to increase median survival from 12 months to about 18 months, with very few side effects caused by the device. Patients with resectable cancers are still treated with surgery, but TTF can be used by patients for whom surgery is not an option.

Palliative Treatment for Mesothelioma

Palliative treatments can help to address symptoms and improve patient comfort. Options may include:

  • Palliative surgery, which is targeted toward symptom reduction rather than complete tumor removal. The surgeon may remove a particular tumor or part of a tumor that’s causing significant symptoms.
  • Palliative chemotherapy and/or radiation therapy may also be used to shrink tumors that are causing symptoms.
  • Thoracentesis involves inserting a needle or catheter through the chest wall to drain a fluid buildup from around the lungs (known as a pleural effusion), to relieve symptoms like shortness of breath.
  • Paracentesis is a similar procedure in which fluid buildup in the abdomen (called ascites) is drained using a needle or catheter inserted through the abdominal wall.
  • Pleurodesis, which may help patients who experience repeated pleural effusions. A thoracoscope is used to insert a medication between the two layers of the pleura. This causes the layers to adhere to each other, so that fluid can’t build up between them.

Palliative treatments may be the primary treatment modality used in some patients, such as those in advanced stages. There are also some patients who choose to forego aggressive treatments for mesothelioma, choosing instead to focus on supportive care to maintain quality of life during their remaining time with their loved ones.

For those who are receiving life-extending treatments, palliative options can be used alongside these to increase patient comfort.

Complementary and Alternative Treatments for Mesothelioma

In addition to these treatments, some patients choose to try complementary and alternative medicine (CAM) treatments. These types of treatment are not a replacement for conventional oncology and surgery but may be used to help with symptom control and comfort. Some options might include:

  • Acupuncture. Some patients find this helpful for reducing pain and nausea.
  • Transcutaneous electrical nerve stimulation (TENS), which uses small electrical signals passed through the skin to stimulate certain nerves. This can be helpful with pain control.
  • Mindfulness, which may involve the use of techniques like meditation and/or yoga. This can help some patients to manage the stress of their diagnosis.
  • Herbs and supplements, which some patients find helpful for symptoms like nausea and pain.

Patients who are considering using any type of complementary or alternative treatment should definitely discuss this with their cancer care team. Certain CAM treatments, such as supplements, can interact with conventional treatments for mesothelioma, so it’s crucial that your team is aware of everything that you’re doing.

Clinical Trials

Although mesothelioma is currently considered incurable, there is a lot of cancer research currently ongoing to discover better ways of treating this disease. Some of the emerging treatment options include:

  • Photodynamic therapy (PDT). This type of therapy involves using a photosynthesizer, which is a medication that’s activated by light. During surgery, the surgeon shines a particular light onto the cancer cells, which activates the medication in order to destroy the cells. The side effects are minimal, since the drug will not be exposed to light and activated in other parts of the body. This does need to be combined with surgery to be effective, but is a promising new treatment option.
  • Gene therapy. This form of treatment is now being tested for many different types of cancer. It uses a modified virus to deliver genetic material to the cancer cells. The new genes integrate into the cancer cells, which can help other medications to target and destroy them.
  • Immunotherapy isn’t entirely experimental anymore, as two forms of immunotherapy are now FDA-approved for treating mesothelioma. Research is still ongoing to discover new types of immunotherapy that may be more effective.

There are also some clinical trials that involve testing existing treatments, such as surgery, chemotherapy, and radiation therapy, in order to discover the best treatment combinations and the ideal timing for each.

Some patients choose to participate in a clinical trial. The biggest advantage is that you might get early access to a novel treatment with the potential to extend your life. However, although these new treatments are considered very promising, there’s no guarantee that they’ll work better than the existing treatments do.

If you’re considering participating in a clinical trial, we recommend talking it over with your oncologist, so you can discuss the pros and cons of participating. Your oncologist can also help you to determine which clinical trials you may be eligible for. You can try searching the National Cancer Institute’s database of current clinical trials for your type of mesothelioma, to see if there are any that you’d like to consider.

Treatment Centers

Mesothelioma treatment generally involves several different specialists, including medical oncologists, cancer surgeons, radiation oncologists, and others. In order to have access to all of the specialized care that you need, it’s often best to receive your treatment at a cancer center. Because mesothelioma is a relatively rare malignancy, most doctors have seen few if any cases of it. At a cancer center, you’ll have access to experts in this specific type of cancer. You can even seek out specific doctors who are experts in your type of mesothelioma.

The National Cancer Institute’s database of cancer centers is a good place to start looking for centers. Some patients prefer to choose a center that’s located near their home, while others are willing to travel to receive their treatment from the top experts in the field.

Treatment Cost

The cost of mesothelioma treatment can add up quickly. Even for patients with Medicare and/or private medical insurance, the deductibles and co-pays for cancer treatment can quickly become hard to manage. Cancer patients may also want to take advantage of complementary therapies that insurance doesn’t cover, adding to the cost.

Asbestos exposure is the only known risk factor for mesothelioma, and the majority of cases are linked to exposure to asbestos. Unfortunately, many companies did not adequately protect their workers from asbestos exposure on the job, even after the dangers of asbestos were known. If your mesothelioma was caused by asbestos exposure at work, then you may be eligible for a financial settlement that could help pay for your treatment.