Researchers at Mexico’s National Cancer Institute say multimodal mesothelioma treatment with chemotherapy, surgery, and radiation can slow tumor growth and improve survival.
Their new study of patients with advanced pleural mesothelioma produced a median survival of nearly two years. That is almost twice as long as average for pleural mesothelioma.
The researchers say the key is a multimodal mesothelioma treatment approach that attacks tumors from three different angles.
Chemotherapy Alone is Rarely Enough
Chemotherapy is still the main treatment for most patients with pleural mesothelioma. The FDA approved pemetrexed (Alimta) in 2004. Until the recent approval of a combination of Opdivo and Yervoy, Alimta was the only drug for mesothelioma. It is still the main component in mesothelioma chemotherapy.
But chemotherapy is almost never a mesothelioma cure. Most patients require multimodal mesothelioma treatment. Multimodal means several different types or “modes” of treatment in combination.
The main mesothelioma treatments include:
- Radical Surgery
- Conservative Surgery
- Tumor Treating Fields
There are many possible variations within each category. Mesothelioma patients may have chemotherapy by itself, with tumor treating fields or immunotherapy, or before surgery (neoadjuvant) to shrink a tumor. Or they may have it after surgery (adjuvant) to kill residual cells.
The same is true for immunotherapy and radiation. Scientists are still trying to find the best multimodal mesothelioma treatment combination.
Three-Part Multimodal Mesothelioma Treatment
The new study focused on patients with advanced pleural mesothelioma. These patients had three-part multimodal mesothelioma treatment, starting with chemotherapy. If their tumors did not grow, they underwent pleurectomy/decortication (PD) surgery.
After surgery, patients had precision radiation with IMRT. IMRT allows doctors to target just one area of the chest. IMRT helps reduce radiation side effects by protecting other organs.
Doctors say the multimodal treatment stopped the growth of the main tumor for most patients.
“The estimated locoregional-relapse-free survival at two years was 75.9% and the main pattern of recurrence was distant (72.7%),” writes lead author Dr. Oscar Arrieta. Among the 15 patients who had the three-part treatment, the median overall survival was 23.6 months.
More than half of the patients developed radiation pneumonitis but none of them died from it.
The researchers conclude that this multimodal mesothelioma treatment “is a feasible and safe treatment modality” that helps keep tumors in check. The next step is to verify these results in a larger study.
Arrieta, O, et al, “Locoregional control and toxicity after pleurectomy/decortication and intensity-modulated pleural radiation therapy in patients with malignant pleural mesothelioma”, October 8, 2020, Thoracic Cancer, Epub ahead of print, https://onlinelibrary.wiley.com/doi/10.1111/1759-7714.13668