Mesothelioma Responds Best to Multi-Modality Treatment, Expert Says

Patients with mesothelioma have a better chance of survival when they are treated with multiple treatment modalities rather than chemotherapy alone.

That is the advice of renowned mesothelioma expert Dr. Robert Cameron of UCLA. Dr. Cameron is a cardiothoracic surgeon and surgical oncologist who pioneered the lung-sparing surgical technique for mesothelioma known as pleurectomy/decortication and has treated mesothelioma patients for more than 20 years. In an article for the Pacific Heart Lung and Blood Institute’s website, he cautions patients and oncologists against relying too heavily on Alimta/cisplatin, the only FDA-approved chemotherapy combination approved for mesothelioma.

“Lost in the hype [over Alimta/cisplatin] is the fact that the FDA’s approval is limited to use with patients who are not eligible for surgery,” writes Dr. Cameron. “Also the fact that, in its Phase III randomized trial, Alimta/cisplatin showed only a 41% partial response rate and an increased median survival rate of only 2.8 months compared to patients treated with cisplatin alone.”

In contrast, an increasing number of studies indicate much better results for patients who receive chemotherapy in combination with surgery and/or radiotherapy. According to Dr. Cameron, who has performed more than 300 mesothelioma surgeries, surgery can remove the gross tumor in up to 85% of patients, ‘equivalent to a complete pathological response’. Dr. Cameron recommends considering adjuvant therapies such as chemotherapy, radiation and newly-emerging immunotherapy as ways of keeping the disease in remission.

“Treating and managing mesothelioma as a chronic illness acknowledges the refractory nature of the disease to all therapies and focuses on coping rather than curing,” contends Dr. Cameron. Medical oncologists are urged to refer mesothelioma patients for a consult with a qualified thoracic surgeon with experience in mesothelioma surgery and to take a ‘team approach’ to treatment.

Malignant pleural mesothelioma is a rare and aggressive cancer associated with exposure to asbestos. More than 77% of patients who contract mesothelioma can be shown to have been repeatedly exposed to asbestos. Because mesothelioma is not easily diagnosed and is fast-growing, the prognosis has historically not been good. But as worldwide incidence of the disease continues to rise, researchers are actively looking for new, more effective diagnostic methods and more promising therapies.

Sources:

Cameron, Robert. “The argument against chemotherapy as a stand-alone treatment for mesothelioma”, Pacific Heart Lung & Blood Institute website, accessed August 30, 2010.

Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Annals of Occupational Hygiene. Dec 2000;44(8):565-601.