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Mesothelioma Treatment

The most effective treatment for pleural mesothelioma combines surgery, chemotherapy and radiation therapy. Other therapies are available to alleviate symptoms and reduce treatment side effects to improve quality of life.

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What Are the Most Common Mesothelioma Treatment Options?

Undergoing treatment helps people live longer with malignant pleural mesothelioma. The longest survival rates are seen among patients who undergo a combination of surgery, chemotherapy and radiation therapy.

This treatment approach is called multimodal therapy, and it helps some people live for years with mesothelioma. Patients must be in good health and diagnosed at an early cancer stage to be eligible.

Emerging treatment options for pleural mesothelioma such as immunotherapy, photodynamic therapy and anti-angiogenic therapy are available through clinical trials.





 
Dr. Jacques Fontaine discusses the most common treatment options for pleural mesothelioma patients.

Surgery

Surgery has proven to be the best standard treatment option for long-term survival. It is also used to control symptoms.

Specialists have developed two tumor-removing surgical procedures for pleural mesothelioma. A pleurectomy and decortication spares the lung, while an extrapleural pneumonectomy completely removes the cancerous lung.

There are also two palliative surgical options that focus on treating pleural effusion, one of the most common symptoms of pleural mesothelioma. Pleural effusion is fluid that accumulates in the space around the lungs. It can make breathing painful and difficult.

Surgeons must determine whether a patient has resectable or unresectable mesothelioma to identify the best candidates for tumor-removing or palliative surgery.

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Extrapleural Pneumonectomy

An extrapleural pneumonectomy, also known as an EPP, is an extensive surgery involving the removal of the entire affected lung, the linings of the chest and heart, and the diaphragm. Though this procedure gives the surgeon a good chance of removing the tumor from the body, removing a lung also permanently impairs the patient’s stamina.

Pleurectomy and Decortication

A pleurectomy and decortication, also known as P/D, is a less radical surgery in which the surgeon removes the linings of the chest and heart, and sometimes the diaphragm, but spares the lung. This procedure has become a good option for multimodal therapy, because it provides similar benefits as an extrapleural pneumonectomy with fewer risks of complications.

Thoracentesis

A thoracentesis procedure drains the fluid from a pleural effusion, relieving the pressure on the lung.

Pleurodesis

A pleurodesis procedure drains the fluid and goes a step further by also sealing the pleural space to prevent any further fluid buildup.

Chemotherapy

Chemotherapy is the most widely received treatment for mesothelioma. Since most patients don’t qualify for surgery, chemotherapy is the next best option.

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 through an IV.

The most commonly used chemotherapy drugs for pleural mesothelioma is a combination of cisplatin and Alimta (pemetrexed). On its own, chemotherapy can slow cancer progression, ease symptoms and prolong survival.

When combined with other therapies, chemotherapy can improve treatment results.

Chemotherapy drugs damage cells that divide quickly, which is what makes chemotherapy an effective cancer treatment. However, because there are also many normal cells in the body that divide quickly, chemotherapy usually has harsh side effects.

Chemotherapy Side Effects

Radiation Therapy

Radiation therapy is used for specific purposes in malignant pleural mesothelioma treatment. It uses high-energy particles to damage the DNA in cancer cells, which stops them from growing and dividing.

Radiation therapy has been used to prevent tumor spreading to incisions after surgery. However, a 2019 phase III clinical trial published in the Journal of Clinical Oncology found it relatively ineffective for this purpose.

As a palliative treatment for late-stage patients, radiation can shrink tumors and significantly relieve pain.

Radiation therapy is painless during the procedure, but it can have some side effects.

Radiation Therapy Side Effects

Depending on the dosage and frequency of the radiation, long-term radiation damage may also occur.

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Multimodal Therapy

The most effective multimodal therapy approach for mesothelioma treatment is a combination of surgery, chemotherapy and radiation therapy. About 20 percent of pleural mesothelioma patients qualify for this aggressive treatment plan.

Establishing a Treatment Plan

Establishing a treatment plan is a coordinated effort between mesothelioma specialists and their patients. Doctors recommend different therapies with the goal of helping patients live as long as possible.

It is up to each patient to decide what treatments they want to undergo. It is important to discuss all the risks and benefits with a medical professional to ensure you thoroughly understand your options.

Complementary Therapies

Complementary therapies are treatments that don’t aim to treat the cancer itself, but instead relieve cancer symptoms or treatment side effects.

Palliative Care

Palliative care, also known as supportive care, aims to control pain, relieve symptoms and improve quality of life.

Palliative care specialists use a wide variety of therapies to manage pain and symptoms.

Ask your oncologist for a referral to a palliative care specialist. This kind of care is complementary at every phase of treatment and recovery.

Alternative Therapies

Many patients turn to alternative medicine for help coping with the symptoms of pleural mesothelioma and the side effects of cancer treatments. These therapies include a diverse range of practices — with some based in the life sciences or mystical belief systems, and others falling somewhere in between.

Alternative therapies vary significantly in terms of the scientific evidence supporting them. For example, yoga, massage and nutritional therapy have proven health benefits, but energy healing techniques, such as reiki, remain a matter of faith.

Consider the following guidelines before trying alternative therapies:

If a certain practice brings you peace of mind, and your medical team has given their approval, then it may indeed help you heal in some way.

New Treatment Options

Doctors are researching and developing new treatment options for pleural mesothelioma, but they require rigorous testing to prove their effectiveness and safety before the U.S. Food and Drug Administration will approve them.

Clinical Trials

Research studies called clinical trials allow scientists and doctors to experiment with drugs and therapies in different combinations and doses, as well as test the safety and effectiveness of entirely new methods of treatment.

The ultimate goal of mesothelioma clinical trials is to find new and improved treatment strategies. Three innovative therapies under investigation include immunotherapy, photodynamic therapy and anti-angiogenic therapy.

Immunotherapy

Immunotherapy is a type of treatment that helps the immune system fight cancer. The Food and Drug Administration has approved immunotherapy to treat several types of cancers, including lung cancer, but not mesothelioma.

Immunotherapy for mesothelioma is available through clinical trials and compassionate use programs. It is most successful when used in addition to standard treatments such as surgery and chemotherapy.

The targeted approach of immunotherapy means some patients experience fewer side effects. However, some patients develop side effects caused by kick-starting the immune system.

Immunotherapy Side Effects

Photodynamic Therapy

Photodynamic therapy uses a light-activated drug called a photosensitizer to kill cancer cells.

The most common photosensitizer used to treat pleural mesothelioma is porfimer sodium, more commonly known as Photofrin. The drug is usually injected into a vein, allowing it to spread throughout the body’s cells.

It remains in cancerous cells longer than in healthy cells, and treatment begins two or three days after the drug has left most of the healthy cells. This therapy is primarily available through clinical trials, although some mesothelioma surgeons are known to use it outside a trial setting.

Because it does not target healthy cells, this pleural mesothelioma treatment has fewer side effects than standard chemotherapy.

Anti-Angiogenic Therapy

Anti-angiogenic drugs prevent tumors from forming new blood vessels, which allow cancer cells to spread to new locations. These drugs work by preventing tumors from spreading, a process known as metastasis.

Researchers are making significant progress in the development of these drugs for mesothelioma.

Anti-angiogenic drugs are typically given in combination with chemotherapy. These drugs are known to increase the side effects patients experience, but under the right medical supervision the side effects are manageable.

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Recurring Mesothelioma

Mesothelioma treatment can put the cancer into partial remission, which means tumors either shrink or stop growing. Unfortunately, the cancer usually returns, and this is called a mesothelioma recurrence.

Second-line therapies are available to treat recurring mesothelioma.

How patients respond to second line treatment depends on a number of factors such as their age, overall health and how fast their tumors are growing.

Mesothelioma Specialists and Treatment Centers

It is important to work with a pleural mesothelioma specialist to access the best treatment. These specialists are located at cancer centers featuring the most innovative approaches to treating mesothelioma.

A pleural mesothelioma patient’s best hope of improving their prognosis is to seek a team of medical professionals with experience treating the disease.

There are several specialized cancer centers spread across the United States with expert staff dedicated to developing the best treatments for mesothelioma patients.

What Is the Cost of Mesothelioma Treatment?

A patient’s treatment options will depend on the specifics of their diagnosis, and their out-of-pocket expenses will depend on their health insurance coverage.

Financial assistance is available to many pleural mesothelioma patients.


Snehal Smart, M.D.

Snehal Smart, M.D.

Snehal Smart is the Pleural Mesothelioma Center’s in-house medical doctor, serving as both an experienced Patient Advocate and an expert medical writer for the website. When she is not providing one-on-one assistance to patients, Dr. Snehal stays current on the latest medical research, reading peer-reviewed studies and interviewing oncologists to learn about advancements in diagnostic tools and cancer treatments.

Medically Reviewed By Dr. Joanne Getsy
Last Modified May 8, 2019

8 Cited Article Sources

  1. Bayman, N. et al. (2019, March 28). Prophylactic Irradiation of Tracts in Patients with Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial. Retrieved from https://ascopubs.org/doi/10.1200/JCO.18.01678
  2. Gooijer, C.J., Baas, P., & Burgers, J.A. (2018). Current chemotherapy strategies in malignant pleural mesothelioma. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204415/
  3. American Cancer Society. (2018, November 16). What’s New in Malignant Mesothelioma Research and Treatment? Retrieved from https://www.cancer.org/cancer/malignant-mesothelioma/about/new-research.html
  4. American Cancer Society. (2018, July 2). Radiation Therapy Basics.  Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/basics.html
  5. Laszlo, V. et al. (2018, May 3). Nintedanib is active in malignant pleural mesothelioma cell models and inhibits angiogenesis and tumor growth in vivo. Retrieved from http://clincancerres.aacrjournals.org/content/early/2018/05/03/1078-0432.CCR-17-1507
  6. Scherpereel, A. et al. (2018). Novel therapies for malignant pleural mesothelioma. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29508763
  7. Brosseau, S. et al. (2017). A review of bevacizumab in the treatment of malignant pleural mesothelioma. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29086616
  8. Lindenmann, J. et al. (2012, November 21). Mutlimodal Therapy of Malignant Pleural Mesothelioma: Is the Replacement of Radical Surgery Imminent? Retrieved from http://icvts.oxfordjournals.org/content/16/3/237.long

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