Understanding Treatment Options for Malignant Pleural Mesothelioma

Malignant pleural mesothelioma is a rare type of cancer and standard therapies are limited. Therefore, most patients consider one or more of three treatment options. These paths use different types of therapies and they are usually not exclusive. Mesothelioma patients can move from one type to another and, if their doctors agree, can sometimes use them in combination.

A new publication gives an overview of the best treatment options currently available for malignant pleural mesothelioma.

Standard therapies include chemotherapy, radiation, and surgery. If more than one of these therapies is used it is may be called multi-modality therapy. Oncologists are the doctors who provide chemo and radiation. Of course, surgeons provide surgeries.

Understanding the Mesothelioma Diagnosis

Malignant pleural mesothelioma is a rare type of cancer. It has a rising incidence which will continue worldwide until around 2030. Malignant pleural mesothelioma patients often face a poor prognosis. Many have only 4 to 12 months of survival after diagnosis if untreated. Most treatments aim to improve the patient’s quality of life and prolong survival.

Malignant pleural mesothelioma is caused by exposure to asbestos. The discovery of asbestos exposure causing malignant pleural mesothelioma was in 1960. Yet, it took several decades to reduce global asbestos use and exposure.

Asbestos was often used as a cheap and fire-resistant material for building construction. Many governments now prohibit the use of asbestos. But it is still used in developing countries. Almost 80% of all mesothelioma patients have a history of asbestos exposure.

There are three major subtypes of malignant pleural mesothelioma. The most common epithelial type affects almost 50% of patients. The sarcomatoid type is more aggressive and affects 16% of patients. The mixed/biphasic type affects 34% of patients.

Doctors use a surgical or tissue biopsy to identify a patient’s mesothelioma type. Type identification is very important for the choice of the right treatment options.

Mesothelioma Treatment Options

Surgical removal of the mesothelioma tumor is one treatment option. Surgery helps with both therapeutic and diagnostic purposes. Of all the conventional therapies surgery, alone or in combination with chemotherapy is considered the most effective standard therapy. Most surgeries for mesothelioma are complex and invasive. Therefore, if a surgery is contemplated it is important to get the best and most experienced mesothelioma surgeon you can find.

Radiation therapy (RT) is seldom used alone in the treatment of mesothelioma. Today, RT is usually part of a multi-modality therapy used with chemotherapy and/or surgery. It is used in adjuvant, neoadjuvant, and palliative settings. But this treatment option is limited by the proximity of the tumor to organs at risk.

When surgery is not a good option, there is a combination of nivolumab and ipilimumab. This is a first-line therapy treatment that is FDA-approved. This treatment is best for the sarcomatoid and biphasic subtypes. The epithelioid type has a benefit from nivolumab and ipilimumab as well. But the advantage is not as strong.

Chemotherapy is a common treatment option. Patients may have chemotherapy alone or in combination with other treatment options. The most common is pemetrexed-based chemotherapy combined with cisplatin. Since chemotherapy for mesothelioma consists of essentially the same drugs across the country, the chemo a mesothelioma patient receives in California will probably be exactly the same as what is administered to a similar patient in New York or anywhere else in the U.S.

Alternative modalities can go by a number of different names: alternatives, holistic medicine, integrative medicine, complementary. At its core, alternative modalities use a different paradigm from conventional treatment options and most clinical trials. Whereas, standard therapies seek to kill mesothelioma cancer cells, alternative modalities seek to harness the body’s immune system and other facilities to either eliminate the cancer or stop it from growing and spreading. Alternative modalities include vitamin therapy, herbs, detoxification, dietary therapy, mind-body medicine, Traditional Chinese Medicine, cannabis oil, and others.

Source:

Sandach, Patrick, Robert Seifert, Wolfgang P. Fendler, Hubertus Hautzel, Ken Herrmann, Sandra Maier, Till Plönes, Martin Metzenmacher, and Justin Ferdinandus. “A Role for PET/CT in response assessment of malignant pleural mesothelioma.” In Seminars in Nuclear Medicine. WB Saunders, 2022. https://doi.org/10.1053/j.semnuclmed.2022.04.008