A comparison of chemotherapy alone versus surgery-based tri-modality treatment for mesothelioma shows patients who take the more aggressive path tend to live much longer.
Malignant pleural mesothelioma is a rare cancer with a poor prognosis. Many patients die within a year of diagnosis. Chemotherapy is the most common treatment.
But chemotherapy alone is rarely enough to stop this aggressive cancer. Tri-modality mesothelioma treatment combines several different types of therapies. The goal is to attack mesothelioma from different angles.
Now, a new study suggests that patients who go this route triple their survival over those who choose more conservative treatment.
Surgery-Based Tri-Modality Mesothelioma Treatment
Pleural mesothelioma is a fast-growing malignancy on the lining around the lungs. It is almost always caused by asbestos exposure. Mesothelioma can lie dormant or “latent” for years before symptoms develop. By the time a person suspects they have mesothelioma, the disease may be very hard to treat.
The first line of defense against mesothelioma is usually chemotherapy with Alimta (pemetrexed). Alimta was the first drug approved for mesothelioma in 2004.
Tri-modality mesothelioma treatment is a newer development. This approach combines chemotherapy with surgery to remove the cancer and radiation to kill remaining cells.
Patients can struggle to know which approach to take. Tri-modality mesothelioma treatment is more aggressive and has more risk. But new data suggests it also has more potential rewards.
Aggressive Treatment Extends Survival
The new study compared mesothelioma treatment success at two different hospitals. The study subjects received treatment between 2009 and 2016.
One-hundred and six pleural mesothelioma patients (cohort 1) received tri-modality mesothelioma treatment at a university hospital in London. These patients had systemic chemotherapy followed by pleurectomy/decortication (P/D) surgery. Finally, they had prophylactic radiation to help keep their cancer from coming back.
Ninety-eight patients (cohort 2) received chemotherapy only at the Quebec Heart and Lung Institute.
“Median survival was 32 months vs 10 months in Cohort 1 and Cohort 2, respectively,” reports researcher Frédéric Larose with Quebec’s Laval University. Even after adjusting for other factors like age, gender, and cancer subtype, tri-modality mesothelioma treatment still came out on top.
The report, published in the journal Lung Cancer, concludes, “Aggressive therapy of MPM using cancer-directed surgery, systemic chemotherapy and prophylactic radiotherapy may provide a significant survival benefit in selected patients.”
Even so, mesothelioma therapy decisions will always vary by case according to risks and benefits. The course of treatment for mesothelioma is a personal decision for patients, their families, and their doctor.
Larose, F, et al, “Malignant pleural mesothelioma: Comparison of surgery-based trimodality therapy to medical therapy at two tertiary academic institutions”, May 3, 2021, Lung cancer, Online ahead of print, https://pubmed.ncbi.nlm.nih.gov/33962765/