There has been some encouraging news this month for patients suffering from an aggressive form of lung cancer called malignant pleural mesothelioma. New research suggests that, even in patients with advanced mesothelioma, long-term survival is possible with a strategic multi-modal approach.
The new mesothelioma study, conducted at several US medical centers and published in the Annals of Thoracic Surgery, analyzed the survival rates of 73 patients diagnosed with the epithelioid form of pleural mesothelioma between 2005 and 2013. All of the patients had been treated with a combination of pleurectomy/decortication (PD) surgery and intraoperative photodynamic therapy (PDT).
PD surgery for malignant mesothelioma treatment involves removal of the diseased pleural membrane, portions of the diaphragm, and other at risk tissues. In contrast to the more radical EPP surgery, PD surgery leaves the lungs in place.
Photodynamic therapy requires that mesothelioma tumor cells be pre-treated with a photosensitizing drug and then exposed to a light source on the end of an endoscope. The goal is to kill any residual mesothelioma cells that the surgeon may have missed.
Most of the mesothelioma patients (92%) analyzed for this study also underwent chemotherapy with pemetrexed (Alimta) after their surgery.
Although pleural mesothelioma typically carries a life expectancy of just 12 to 18 months, the median overall survival for patients receiving this PD/PDT therapy combination was more than twice that at nearly three years.
The news was even better for the 19 mesothelioma patients whose cancer had not spread to their lymph nodes; These patients had an overall median mesothelioma survival rate of 7.3 years.
“The role for lung-sparing surgery is unclear but this series demonstrates that it is an option, even for advanced cases,” writes study author Joseph S. Friedberg, MD, mesothelioma researcher at the University of Maryland Medical Center in Baltimore. “The overall survival of 7.3 years for the node negative subset of patients, still of advanced stage, is encouraging.”
These node-negative patients experienced longer survival even though their mesothelioma tumors began growing again a median of 2.4 years after surgery. Dr. Friedberg says this disparity between tumor growth and survival may be related to the impact of the PDT, which is currently being studied as part of a randomized mesothelioma clinical trial.
Friedberg, JS, et al, “Extended Plearectomy-Decortication-based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years”, November 4, 2016, The Annals of Thoracic Surgery, Epub ahead of print