Multimodal Therapy for Mesothelioma
Mesothelioma is a complex form of cancer and is often treated using multimodal therapy. This employs different treatment modalities, including surgery, chemotherapy, and radiation therapy, to increase the patient’s survival rates. Not all patients are candidates for this kind of treatment.
Medically Reviewed By:
Patricia Shelton, M.D.
Medically Reviewed By:Patricia Shelton, M.D.
Mesothelioma is most commonly treated using multimodal therapy, which employs multiple different treatment modalities. This is the most effective way to treat mesothelioma and increases survival rates. Multimodal therapy is an aggressive form of cancer treatment, and not all patients are candidates for using this strategy.
Treatments Used in Multimodal Therapy
Multimodal therapy involves using a combination of different treatment methods in order to eliminate as much of the cancer as possible with the goal of extending the patient’s life expectancy. This form of treatment can significantly extend survival in some patients, although mesothelioma is still considered to be incurable. It’s rare that treatment will completely eliminate all of the cancer, although there have been some reported cases of long-term remission. Multimodal therapy can also be called multimodality therapy; these two terms are interchangeable.
The primary treatments used in multimodal therapy include surgery, chemotherapy and radiation therapy. Other forms of treatment, such as immunotherapy and Tumor Treating Fields (TTF), are not generally part of the main treatment plan but may be used if the primary treatments fail or if the cancer later progresses.
A 2021 study indicated that pleural mesothelioma patients who were treated using multimodal therapy had a median survival time of 32 months, compared with 10 months in those who received only medical treatment. Because of the results of studies like this, most experts recommend multimodal therapy for those patients who are eligible for it.
Most patients receive multimodal therapy at a cancer center. This allows access to the multiple different specialists who will need to be involved in the patient’s care, including medical oncologists, surgeons and radiation oncologists. With a rare type of cancer such as mesothelioma, it’s beneficial to choose a treatment team with expertise in treating this specific type of cancer to maximize the chances of a good outcome. The American Cancer Society also recommends getting a second opinion about your diagnosis before committing to a treatment plan.
Patient Eligibility for Multimodal Therapy
Your oncologist will let you know whether he or she believes that you’re a good candidate for multimodal therapy, and why.
Although multimodal therapy will generally offer the best chances for the longest possible life expectancy, it’s still the patient’s choice whether they want to choose this aggressive form of treatment. Many patients choose to have multimodal therapy in order to maximize the amount of time they have with their loved ones. However, others choose to receive palliative care instead to focus on quality of life in their remaining time rather than enduring the side effects of aggressive cancer treatment. Each patient should talk through treatment options with their cancer care team and carefully consider their own values and goals for their cancer treatment. Ultimately, it’s the patient’s own choice which treatment options they want to pursue.
Multimodal Therapy for Pleural Mesothelioma
The specific treatment plan for pleural mesothelioma can vary somewhat from patient to patient. Treatments that may be part of multimodality therapy for pleural mesothelioma include:
Most commonly, multimodal therapy involves using all three of these types of treatments. The order in which the treatments are used differs from patient to patient. Research doesn’t clearly indicate that one specific way of performing multimodal therapy is superior to others, although clinical trials are currently investigating various ways of combining cancer therapies to discover which are the most effective.
Multimodal therapy involves up to three phases:
Neoadjuvant therapy is not always used. In some cases, a patient’s treatment plan may begin with surgery and then continue to one or more forms of adjuvant therapy. Others will start with either chemotherapy or radiation, followed by surgery, and then adjuvant treatment afterwards. The available evidence shows that adjuvant and neoadjuvant chemotherapy have approximately equal effectiveness overall.
The specifics of the treatment plan vary between different patients. Various patient factors as well as characteristics of the cancer will be considered when formulating the treatment plan. Different cancer centers also tend to use different protocols, although these can be adapted for different patients. Because mesothelioma is a rare form of cancer, it’s best to choose a cancer treatment team with experience in treating this specific malignancy.
Second-Line Treatments for Pleural Mesothelioma
Multimodal Therapy for Peritoneal Mesothelioma
The most effective treatment for peritoneal mesothelioma is a multimodality treatment plan that combines surgery and chemotherapy. This is known as CRS-HIPEC, and it’s considered the gold standard of peritoneal mesothelioma treatment. Studies at various institutions have shown average life expectancy after the procedure of between 34 and 92 months, and five-year survival rates of 29 to 59 percent.
In general, it’s strongly recommended that patients who are candidates for CRS-HIPEC choose this treatment modality because it offers the best chance of survival. For those whose cancer is not successfully treated by CRS-HIPEC, or whose cancer has progressed after surgery, the next line of treatment is often systemic chemotherapy.
Additional treatment options, like immunotherapy and Tumor Treating Fields, have been FDA-approved for pleural mesothelioma that has recurred after surgery. These modalities are not currently approved for treating peritoneal mesothelioma patients.
However, there are clinical trials that are investigating new treatment options for peritoneal mesothelioma. For patients whose cancer has recurred after CRS-HIPEC, a clinical trial might be an option. Your treatment team can help you weigh the risks and benefits of participation in a trial and determine which trials you would be eligible for.