The most common treatment for mesothelioma includes a mixture of radiation, chemotherapy, and surgery. Treatment may also include experimental therapies like immunotherapy, gene therapy, and cryotherapy, or palliative care designed to ease symptoms of the cancer.
While there is no cure for mesothelioma, treatment can significantly improve a patient’s prognosis, life expectancy, and quality of life. A treatment plan will be created in collaboration with the patient’s medical team and will take into account diagnostic factors, the health and age of the patient, and whether the cancer has spread.
The process for treating mesothelioma can involve:
- One or more forms of conventional treatment;
- An experimental therapy delivered as part of a clinical trial;
- Complementary and alternative treatments;
- Palliative care to ease the discomfort and pain of symptoms
Most mesothelioma treatment is delivered as part of a multimodal plan, which means that it is delivered in multiple phases – usually three, though the number varies from patient to patient. The three phases are:
- Neoadjuvant Therapy: A treatment that aims to make the primary therapy as effective as possible.
- Primary Therapy: The main treatment intended to remove tumors or kill the cancer cells.
- Adjuvant Therapy: A “helping” treatment that further boosts the effectiveness of the primary therapy.
This multimodal approach allows different therapies to work concurrently together to provide the best possible outcome for the patient. It has been tested and refined over the course of the last several decades, and it seems to offer the best opportunity for mesothelioma patients to improve their prognosis.
A typical multimodal treatment process for mesothelioma would look something like the following.
|Neoadjuvant Therapy||Primary Therapy||Adjuvant Therapy|
|Radiation – Used to shrink the tumor(s)||Surgery – Removes the tumor(s) from the body||Chemotherapy – Kills remaining cancer cells left after surgery|
Remember that not all treatment plans will be conducted the same way. Modes of therapy may be switched around or replaced with something else. For example, some clinical trials are studying the effects of using emerging treatments, such as immunotherapy, in different phases of treatment.
Conventional Mesothelioma Treatments
The standard treatments for mesothelioma are those that have been used for many years in an attempt to eradicate the cancer or improve a patient’s quality of life. Some treatments are more intensive than others and may not be available for all patients.
The goal of mesothelioma surgery is to remove as much of the cancer as possible. This often means removing part or all of the tissue or organ where tumors have developed.
Mesothelioma surgery is typically only viable when the disease is diagnosed at an early stage. Once the cancer starts to spread (metastasize) throughout the body, there is little to no chance that surgery will be effective.
Surgeries by Mesothelioma Type
|Pleural Mesothelioma||Peritoneal Mesothelioma||Pericardial Mesothelioma|
|Pleurectomy – Removal of lung lining (pleura)|
Pneumonectomy – Removal of an entire lung
Extrapleural Pneumonectomy – Removal of an entire lung, plus some surrounding tissue
|Peritonectomy – Removal of the abdominal lining (peritoneum)|
Cytoreduction/Debulking – Removal of tumors from abdominal organs, including possibly removal of certain organs altogether
|Pericardiectomy – Removal of the heart lining (pericardium)|
Note: Surgery may also be used during the diagnostic process to obtain tissue for a biopsy.
A common treatment for many types of cancer, chemotherapy works by killing fast-growing cells, such as mesothelioma cells. It can be used at any phase of a multimodal therapy plan, or it may be delivered on its own as a standalone treatment.
Chemotherapy can be delivered in one of two ways:
- Systemic Chemotherapy: The most common form of chemotherapy is to administer it intravenously or as a pill. In this method, the drug will travel throughout the entire body and kill any mesothelioma cells (and other fast-growing cells) it comes into contact with.
- Intraoperative Chemotherapy: A newer delivery method is to apply heated chemotherapy drugs directly to the area of the body from which tumors are removed. This is usually done during surgery, to kill any traces of cancer that might have been left behind.
The most effective form of chemotherapy for mesothelioma is a combination (“cocktail”) of Alimta (pemetrexed) and cisplatin. Another drug, the Avastin (bevacizumab), is sometimes combined with these two chemotherapy drugs to increase their effectiveness.
Other chemotherapy drugs sometimes used with mesothelioma include carboplatin, Gemzar (gemcitabin), Onconase (ranpirnase), and Navelbine (vinorelbine).
Radiation has been shown stop the growth of mesothelioma tumors and in some cases even shrink them. This is why radiation is sometimes used as a neoadjuvant therapy, to make tumors smaller before surgery, making it easier for the surgeon to remove them.
Because radiation can damage the body, and even cause some forms of cancer itself, it is used sparingly. A newer form of radiation that uses a tighter beam is being tested to see if it can be effective against mesothelioma while reducing damage to surrounding tissue.
Experimental Mesothelioma Treatments
While conventional treatments have shown to be somewhat effective in helping some mesothelioma patients improve their prognosis, they are far from perfect. As a result, researchers and practicing doctors continue to look for new and more effective treatments. The emerging therapies listed below are those that have shown the greatest promise.
Immunotherapy is a term used to encompass a wide range of new types of treatment that are designed to enhance the body’s natural immune system. Some of the best results for new mesothelioma treatments have come from clinical trials studying immunotherapy drugs.
The most promising immunotherapy drugs are:
- Keytruda (pembrolizumab): Already approved for some types of cancer – including non-small-cell lung cancer (NSCLC), melanoma, and metastatic head and neck squamous cell carcinoma (HNSCC), Keytruda has shown to be an effective treatment for some mesothelioma patients when other treatments have had little or no effect.
- Avastin (bevacizumab): Designed to stop the growth of blood vessels that feed mesothelioma tumors, Avastin has been recommended by the National Comprehensive Cancer Network as part of a first-line chemotherapy treatment for unresectable pleural mesothelioma. It has been approved to treat many other types of cancer already.
- Tecentriq (atezolizumab): Already approved to treat metastatic NSCLC, Tecentriq is being studied as a potential new therapy for mesothelioma. It is still in early trials, but results so far are promising.
Immunotherapy is one of the big focuses of the Cancer Moonshot Initiative started in 2016 by former Vice President Joe Biden. It is one of the most promising areas of cancer research in general.
There are several types of gene therapy, each of which focuses on different ways to repair or replace problematic gene sequences that lead to the development of cancer. The most common type of gene therapy being studied for mesothelioma is virotherapy, which uses modified viruses to deliver new gene sequences.
- Suicide Gene Therapy: Cells in the body naturally have what is known as a “suicide gene,” which is triggered when it is time for the cell to die. Cancer cells, however, have no such suicide gene, which is why they continue to grow and reproduce. Suicide gene therapy triggers the suicide gene in cancer cells, so they die naturally like they are supposed to.
- Cytokine Gene Therapy: Cytokine, which literally means “cancer killing,” uses specific proteins that act as signals for nearby cells. In this type of treatment, the goal is to get cancer cells to release cytokine proteins so that they will be attacked and killed by nearby white blood cells.
- p53 Gene Therapy: Another protein known as p53 is defective in most forms of cancer. Some researchers believe that learning how to repair the p53 protein could ultimately lead to a cure for cancer.
Gene therapy and immunotherapy are not necessarily two different types of treatment. Some forms of gene therapy focus on triggering an immune system response, making that treatment both gene therapy and immunotherapy.
Researchers have discovered that by using a chemical known as a photosensitizing agent, they can target and kill cancer cells using a light source. This method is much less invasive and damaging to the body than other types of treatments, though it is not completely free of side effects.
While photodynamic therapy shows promise as a mesothelioma treatment, it is not yet being used as a standalone method of fighting the disease. Researchers continue to look for more effective photosensitizing agents that can better target specific cancer cells, as well as light sources that can penetrate into tumors buried deep within the body.
Another technique that has been researched as a treatment for mesothelioma is cryotherapy (also called cryoablation). This method uses extremely cold temperatures to freeze and kill tumors by injecting a gas into them.
While cryotherapy it has been shown to be effective at stopping tumor growth, it is not a cure for mesothelioma. Additional clinical trials are being conducted to improve the technique.
Complementary and Alternative Mesothelioma Treatments
The treatments listed above are the primary therapies being used to help mesothelioma patients fight their cancer. However, other types of treatment may be used to address issues related to discomfort, stress, mental, emotional, and even spiritual aspects of being diagnosed with cancer.
Alternative Cancer Treatments
Some people have explored the use of alternative treatments to cure cancer, either because conventional or experimental treatments are not working for them, or perhaps due to religious or spiritual beliefs about the treatment.
No alternative cancer treatments have been scientifically shown to be as effective as the treatments approved by the FDA. However, some studies have shown certain forms of alternative treatment – such as massage, meditation, yoga, acupuncture, and art therapy – to be effective at managing stress and discomfort associated with cancer.
Before beginning any alternative treatment, be sure to speak with your doctor about any expected benefits and potential harms. This is especially important if you plan to take any supplements or herbal remedies, since they may interact with your prescriptions. Many oncologists are supportive of a holistic approach to care, especially with terminal illnesses like mesothelioma, but they also will want to be sure not to do any unintended harm to their patients by prescribing something that could hurt them even more.
In many cases, treatment may be given to mesothelioma patients to address symptoms of the disease rather than the underlying disease itself. This helps ease discomfort and can greatly increase the quality of life of the patient.
In addition to addressing the patient’s physical needs, palliative care also attends to their emotional, mental, and spiritual health as well. A palliative care team will often includes medical specialists and counselors in all of these areas, giving the patient access to any of these services he or she needs.
Many people believe that palliative care is only applicable to terminally ill patients, but this is not true. Palliative care is a broad term used to describe methods of treating secondary conditions, and it can be used by those who are actively fighting their cancer diagnosis.
Particularly for mesothelioma patients who undergo surgery, physical therapy is an important aspect of recovery and survival. The most common mesothelioma surgeries involve removing all or part of the lung, which means patients will need to learn how to live with their diminished breathing capacity. The surgery itself is invasive and takes time to heal and recover, as well.
Mesothelioma Treatment Costs
Mesothelioma treatment can be expensive, even for those who have health insurance. Some common costs include:
- Diagnostic procedures
- Surgery (including anesthesia)
- Travel expenses to and from mesothelioma cancer centers
- Follow-up visits to specialists
These costs are a big reason why legal compensation is necessary for many patients. Since mesothelioma is a preventable disease, holding companies accountable that make products that still contain asbestos is one way that these victims can pay for the care they need.