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Trimodal Mesothelioma Treatment May Not Be Worth the Risk

27174753_lungsJapanese researchers say trimodality treatment for mesothelioma that includes chemotherapy, extrapleural pneumonectomy (EPP), and post-surgical radiation may not be beneficial enough to justify the risk.

Pleural mesothelioma is one of the most difficult cancers to treat because it grows quickly and is resistant to most conventional therapies. Most mesothelioma patients have to have a combination of treatments.

The question for researchers is, which treatment combination will provide the best mesothelioma survival outcomes.

Trimodality Treatment for Mesothelioma

In the newest study on trimodality treatment for mesothelioma, the Japanese team enrolled newly-diagnosed pleural mesothelioma patients who had not yet had any treatment.

Study participants were given a chemotherapy combination of pemetrexed and cisplatin to shrink their mesothelioma tumors. This was followed by EPP surgery to remove the mesothelioma tumor, the nearest lung, and other at-risk tissues.

The final part of the trimodal mesothelioma treatment was postoperative hemithoracic (one-sided) radiation therapy.

Benefits of Trimodal Mesothelioma Treatment

The research team set goals for their study including thoroughness of the surgery (called macroscopic complete resection) and treatment-related mortality.

Of the 42 eligible mesothelioma patients, 30 (71 percent) experienced macroscopic complete resection. Just over 9 percent of patients died of complications from the treatment.

Not Worth the Risk?

The overall median survival time for the 42 registered mesothelioma patients was 19.9 months. Just over 42 percent of patients lived for 2-years after their trimodal mesothelioma treatment.

Unfortunately, although some patients had promising results from the approach, most did not see enough benefit to justify the risks.

“This phase II study met the predefined primary endpoints, but its risk/benefit ratio was not satisfactory,” writes researcher Seiki Hasegawa of the Hyogo College of Medicine.

The new study is published in the International Journal of Clinical Oncology.


Hasegawa, S, “Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial)”, November 17, 2015, International Journal of Clinical Oncology, Epub ahead of print

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