A Multimodality Treatment Plan may be Best for Pleural Mesothelioma

A multimodality treatment plan may improve mesothelioma patient outcomes. Malignant pleural mesothelioma is an invasive, locally aggressive tumor related to asbestos exposure.

A new study shows that the best treatment plan for pleural mesothelioma may be when different types of therapy work together.

The ideal combination of treatment therapies is still unknown. But a recent study encourages further studies on a multimodality treatment plan. This may include chemotherapy, surgery, and adjuvant radiotherapy.

Current Clinical Guidelines: A History of Single or Multimodality Treatment Plans

Despite a long history of clinical research, there is still no cure or any evidence of the best treatment. Many single-treatment plans, single-modality plans, have had disappointing results.

Researchers have begun to evaluate different multi-modal treatment approaches.

Multimodality therapy seems to be the best treatment for malignant pleural mesothelioma. But the ideal combination of currently used therapies is still undefined. More research is required to build an effective multimodality treatment plan.

Case Series: How Multimodality Treatment Plans Work

A recently published clinical case series included 17 pleural mesothelioma patients. The clinical trial took place at the University of Campania Luigi Vanvitelli in Caserta, Italy. All patients had stage I or II malignant pleural mesothelioma.

Patients included in the clinical case series were a median age of 66 years and mostly male gender. Patients were included in follow-up for a median of 43.4 months total.

Each patient received a multimodality treatment plan. This included induction pleurectomy/decortication (P/D), postoperative radiotherapy (RT), and post-operative induction chemotherapy (CT).

Thoracic surgeons tracked their patient data between 2013 and 2020. Data collected included treatment details, radiological data, therapies used, and disease progression.

Induction therapy was performed every 21 days for two cycles. P/D was performed four to six weeks after induction CT. Postoperative RT was done three to six weeks after surgery. While postoperative CT was given four to six weeks after RT.

Patient Outcomes and Complications

Most patients survived 32.1 months after the multimodality treatment plan. The median progression-free survival was 23.7 months. Progression-free survival is the length of time during and after the multimodal treatment when a patient lives with the disease, but it does not get worse.

Major complications may include cardiac arrest. There were two cases of cardiac arrest with patients in the study. Although both were resolved by manual cardiac massage. Minor complications include anemia, wound infection, persistent air leaks, and hemidiaphragm elevation.

A Bright Future for Multimodality Treatment Plans

Malignant pleural mesothelioma may best be treated through a multimodality treatment plan with different types of therapy.

Physician-scientist Giovanni Vicidomini, from the Department of Translational Medicine, says, “For this malignancy, the main goal in a multimodal strategy is to obtain a complete removal of all macroscopic tumor tissue (cytoreductive surgery), thus improving the effectiveness of subsequent treatments.”

Clinical trials with more patients and over longer periods of time are needed to confirm the value of the multimodality treatment plan.

Sources

Vicidomini, G., Della Corte, C. M., Noro, A., Di Liello, R., Cappabianca, S., Fiorelli, A., … & Santini, M. (2022). A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study. Cancers, 14(1), 142. https://doi.org/10.3390/cancers14010142