Your Treatment Options

Mesothelioma treatment is constantly improving, increasing the probability of a better prognosis for many people diagnosed with the disease. In addition to the standard treatment methods, a number of emerging treatments currently in clinical trials are showing promising results.

surgery treatment option

Although there is no cure for pleural mesothelioma, there are treatment options that enhance survival rates and improve quality of life. In addition to standard treatment options, such as surgery, chemotherapy and radiation, people with this type of cancer may be eligible to participate in clinical trials that test advancements in treatment.

Researchers currently are studying emerging treatments, such as immunotherapy, photodynamic therapy and gene therapy. Advancements in scientific research and technology make it possible for these treatments to impact prognosis, life expectancy and overall quality of life. Eligible patients are encouraged to apply to clinical trials that study these new and innovative courses of treatment.

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Emerging Treatments

As researchers strive to improve current treatments, they are also exploring new therapies to provide more options. Emerging treatments are options that are still in the early stages of development. They are not yet approved by the U.S. Food and Drug Administration, but they are currently used in clinical trials and continue to look promising for the future of mesothelioma.

Immunotherapy

Immunotherapy involves introducing antigens or a man-made immune system component into the body to help it recognize and destroy cancer cells. When combined with other treatments like chemotherapy, immunotherapy can improve survival rates and reduce symptoms.

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Introducing Antigens

Stimulating the immune system’s response to kill cancerous cells by introducing antigens. Antigens are substances the immune system recognizes as foreign, such as chemicals, viruses or bacteria, that are detected by antibodies or y-shaped proteins that bind to and destroy foreign objects in the body.

This can be effective in mesothelioma treatment. Physicians inject the patient with antigenic substances that mimic the tumor's cell surface. These antigens travel to the lymph nodes, where dendritic cells identify them as foreign and deliver them to T cells and B cells. These cells evoke an immune response and the body attacks the tumor.

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Using Laboratory Components

Using immune system components developed in a laboratory, such as man-made proteins, that allow the patient to adopt an enhanced immune response developed in a test tube.

The components used for treatment depend on whether the immunotherapy is specific or nonspecific. Specific immunotherapy involves monoclonal antibodies, cytotoxic T cell clones or lymphocytes to attack the cancerous tumor. Nonspecific immunotherapy uses macrophages, cytokines, lymphocyte activated killer cells (LAK), or bacillus Calmette-Guerin to kill the disease.

Although immunotherapies to treat pleural mesothelioma are still in the beginning stages of clinical trials, the FDA has approved some antibody therapy drugs to treat other cancers, which means there is hope.

Immunotherapy Drug Amatuximab

One pleural mesothelioma immunotherapy drug that is the focus of some clinical trials is the monoclonal antibody named Amatuximab (MORAb-009). Amatuximab targets and alerts the immune system to attack mesothelin, which is a protein found on the surface of mesothelioma tumor cells.

Some studies suggest that Amatuximab helps the immune system kill cells that have high levels of mesothelin. One phase II study of amatuximab plus pemetrexed and cisplatin included 89 patients who completed six rounds of chemotherapy plus amatuximab and an extended period of time with just amatuximab.

immunotherapy clinical trials

Genetherapy

Gene therapy is an experimental technique that manipulates the patients’ genes to treat or prevent disease, like cancer, by repairing defective genes. In the case of pleural mesothelioma, the goal of gene therapy is to shrink the tumor size and improve survival rates when used in combination with chemotherapy or other standard treatment options.

Physicians introduce a genetically modified virus to a patient’s body that specifically targets tumor cells. While healthy cells are left unharmed, the virus attacks the body’s cancerous cells and discharges a genetic material that destroys or kills those cells through apoptosis, or cell death.

Early clinical trials have shown that gene therapy can be safe and effective, but additional research is needed to perfect treatment techniques.

Photodynamic Therapy

Photodynamic therapy (PTD) uses a special light-activated drug, called a photosensitizer, to kill cancer cells. The drug is usually injected into a vein, allowing it to spread throughout all the body's cells. But it remains in cancerous cells for a longer period of time than in healthy cells.

Treatment begins two or three days after the drug has left most of the healthy cells. The doctor targets specific areas with light to activate the drug, inducing a chemical reaction that kills the cancerous cells without damaging the healthy cells. As a result, this treatment has fewer side effects than standard chemotherapy.

Clinical Trials

Scientists and doctors combine their efforts into research studies called clinical trials to test whether a new drug or medical strategy is effective and safe. Clinical trials allow scientists to experiment with new ideas and new drugs for treatment in different combinations and doses. The ultimate goal of these trials is to find a drug that can become FDA-approved to treat a certain diagnosis.

Because pleural is the most widely diagnosed form of this asbestos-related disease, a vast majority of clinical trials aim to discover a cure. Doctors currently are testing several innovative therapies in clinical trials and our Patient Advocates specialize in helping you find clinical trials that are right for you.

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Standard Treatments

Standard treatment options for this rare cancer include surgery, chemotherapy and radiation therapy. As treatment research grows, the combination of two or more of these options, called multimodal approach, has shown promising results for increasing survival rates.

In one study conducted by Dr. David Sugarbaker and others, 120 pleural mesothelioma patients were treated with a multimodal plan that consisted of all three standard treatment options. Results showed a two-year survival rate of 45 percent and a five-year survival rate of 22 percent.

Surgery

Doctors can perform different surgical procedures to treat pleural mesothelioma. Research has confirmed potentially curative surgery is the best standard treatment option for long-term survival.

An extrapleural pneumonectomy (EPP) is an extensive surgery involving the removal of the entire affected lung, linings of the chest and heart, and the diaphragm. It can increase life expectancy and is typically performed for early-stage pleural mesothelioma.

While a pleurectomy/decortication (P/D) is less radical, it's still extensive. The surgeon removes the linings of the chest and heart, and sometimes the diaphragm, but spares the lung. This procedure carries higher success rates than an EPP and has become an attractive option for multimodal therapy.

Chemotherapy

Chemotherapy may be suggested as the primary treatment option for those who are not eligible for surgery. It involves the use of one or more drugs to kill cancer cells and shrink tumors. The drugs are usually delivered into a patient's vein or taken orally as pills. While chemotherapy cannot cure this disease, it can slow cancer progression, help ease symptoms and prolong survival.

Currently, there are more than 100 chemotherapy drugs available, but the most common one for pleural mesothelioma is a combination of Alimta and cisplatin. These drugs are especially effective when used before or after surgery, as part of a multimodal approach.

Radiation Therapy

Radiation therapy uses high-energy rays aimed directly at the tumor area to kill cancer cells. It damages the DNA that causes cells to grow and divide. Radiation alone cannot cure pleural mesothelioma, but when it is used in combination with other treatments, it can successfully relieve pain. It may even prevent the cancer from spreading.

Radiation is typically given to early-stage patients after surgical treatment to prolong survival and prevent the cancer from recurring. For late-stage patients whose cancer is widespread, radiation therapy is often palliative rather than curative. The treatment shrinks tumors on the pleura and lungs, which alleviates painful symptoms and discomfort caused by the cancer's growth.

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Palliative Treatment

If aggressive surgery or other potentially curative options is not recommended for someone with this disease, palliative care may be the best option. Palliative care is treatment given by a team of doctors, nurses and other qualified health care professionals to relieve symptoms and improve quality of life, rather than to cure a disease. It is often referred to as symptom management.

This form of treatment focuses on symptoms, such as shortness of breath, pain, fatigue, coughing, and weakness, which may be caused by the pressure of a tumor or a pleural effusion, the buildup of excess fluid in the lungs.