Radical Multi-Modal Mesothelioma Treatment: Is it Worth It?

A team of Egyptian researchers is calling on mesothelioma doctors and patients to rethink their approach to treating this aggressive, asbestos-linked cancer.

Scientists with Ain Shams University in Cairo conducted a review of studies on radical multi-modality approaches to malignant mesothelioma treatment and concluded that, despite what some other studies seem to suggest, this may not always be the best approach.

What Are Radical Multi-Modal Mesothelioma Treatments?

The standard treatment for malignant mesothelioma – and one which almost every mesothelioma patient receives – is platinum-based chemotherapy. In the US, most patients have a combination of pemetrexed (Alimta) and cisplatin.

But many patients also have at least one other type of mesothelioma treatment, such as surgery, radiation, immunotherapy, or photodynamic (light-based) therapy. This is known as multi-modal or multimodality treatment and many studies have shown it to be the preferred approach to combating malignant mesothelioma.

A procedure is considered “radical” when it is more extensive or intensive than standard therapy. Extrapleural pneumonectomy (EPP), which involves removal of one lung as well as the pleural membrane and other at-risk tissues, is considered a radical mesothelioma surgical approach.

The Egyptian study also included data on combination treatments involving radical radiotherapy and/or radical photodynamic therapy.

Comparing Radical Treatments for Malignant Mesothelioma

In their review of the medical literature on radical multi-modal mesothelioma treatment, the Egyptian team identified two randomised clinical trials that fulfilled their inclusion criteria. The studies involved a total of 104 mesothelioma patients.

One study compared a combination of pre-surgical chemotherapy, EPP, and high-dose hemithoracic (one side of the chest) radiotherapy with EPP and chemotherapy alone.

The other trial compared EPP and hemithoracic radiotherapy with “standard” (non-radical) therapy followed by chemotherapy.

Does Radical Multi-Modal Treatment Work?

In the first trial, the median mesothelioma survival among patients who did not receive radiotherapy was 20.8 months while those in the radiotherapy group had a median survival of 19.5 months.

In the second trial, 12 mesothelioma patients experienced serious side effects from their treatment, including ten who were receiving the more radical multi-modal treatment and two in the standard treatment group.

Median overall survival was just 14.4 months among the mesothelioma patients who underwent EPP but 19.5 months for those who had standard non-radical treatment.

Although the authors of the new study conceded that the studies were small and “the overall strength of the evidence…is low”, they conclude that “there is a lack of available evidence to support the use of radical multimodality therapy in routine clinical practice.”

Summarizing the findings in the Cochrane Database of Systematic Reviews, lead author Omar Abdel-Rahman concludes, “Given the added cost of multimodality treatment and the possible increase in risk of adverse effects, the lack of evidence of their effectiveness probably means that these interventions should currently be limited to clinical trials alone.”

Source:

Abdel-Rahman, O, et al, “Radical multimodality therapy for malignant pleural mesothelioma”, January 8, 2018, Cochrane Database of Systematic Reviews, Epub ahead of print