Conventional treatments for mesothelioma generally consist of chemotherapy, surgery, and sometimes radiation therapy.  Of all three, chemotherapy is the most one size fits all approach because only one chemotherapy drug combination is FDA approved for mesothelioma.  Surgery requires the most expertise and there are only a handful of surgeons in the United States who are skilled and experienced with resecting mesothelioma tumors.

Chemotherapy for Mesothelioma

The standard chemotherapy treatment for mesothelioma (both pleural and peritoneal) is a combination of two drugs: Alimta (pemetrexed) and cisplatin (or carboplatin).  This is the only FDA approved chemotherapy regimen for mesothelioma.

The pivotal study that made this treatment the standard of care that it is was published in the Journal of Clinical Oncology in July 2003.

A total of 456 mesothelioma patients were in the study. 226 received pemetrexed and cisplatin, 222 received cisplatin alone, and eight never received therapy. Median survival time in the pemetrexed/cisplatin group was 12.1 months.  Median survival in the cisplatin only group was 9.3 months.

Median time to progression was longer in the pemetrexed/cisplatin group versus the cisplatin group: 5.7 months versus 3.9 months.

What does this mean?  It means that patients who got this new “standard of care” had a median survival of 12.1 months from diagnosis, and their cancers did not grow (progress) for 5.7 months.

Surgical Treatments for Pleural Mesothelioma

Different surgeries are available to some patients based on a number of variables including:

  • Overall health
  • Staging (spread of cancer)
  • Cell type
  • Hospital and doctor skills and experience

For pleural mesothelioma surgical procedures include:

Pleurocentesis

This procedure is used to minimize pleural effusion, the build-up of fluid in the pleural space surrounding the lungs.

Pleurodesis

Pleurodesis is a surgical procedure that uses chemicals, talc or drugs to scar the space between the layers of the pleura.  This is sometimes referred to as a “talc procedure.”

Pleurectomy/ Decortication

Pleurectomy/ Decortication refers to a lung-sparring surgery to remove the mesothelioma cancer by removing part of the covering of the lungs, lining of the chest, and part of the outside surface of the lungs.

Pneumonectomy

A pneumonectomy is a surgery that involves the removal of the lung that has been affected by mesothelioma.  It has become the standard surgery for operable locally advanced lung cancer.

Extrapleural Pneumonectomy

An Extrapleural Pneumonectomy or EPP is the most invasive surgery for mesothelioma and involves the removal of the diseased lung, part of the pericardium, (the membrane that covers the heart), part of the diaphragm (the muscle that lies between the abdomen and the lungs), and part of the parietal pleura (this is the membrane that lines the chest).  y.

 

Surgical Treatments for Peritoneal Mesothelioma

Paracentesis

Similar to pleurocentesis, paracentesis is a procedure in which fluid from the abdomen is removed through a needle.

Peritonectomy/ Cytoreductive Surgery

Peritonectomy is the most common surgical procedure for peritoneal mesothelioma and involves the removal or stripping of the affected peritoneum (cancerous part of the lining of the abdominal cavity) from the underlying tissue.

 

Radiation Therapy for Mesothelioma

Radiation therapy is rarely used alone in the mesothelioma treatment.  Most centers now use it as part of a multi-modal approach.  For example, tri-modal therapy often consists of chemotherapy, surgery and radiation therapy.

To see some of the actual results of various conventional mesothelioma treatments for mesothelioma, please click here.