The treatment of pleural mesothelioma 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.
Although there is no cure for pleural mesothelioma, these treatment options enhance survival rates and improve quality of life.
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 improve 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.Connect to a Top Pleural Mesothelioma Doctor
As researchers strive to improve current pleural mesothelioma 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 pleural mesothelioma.
Immunotherapy is a type of treatment that uses the body’s own immune system to help fight against diseases like cancer. The immune system is complex, but recognizing how it works on a basic level might help in the understanding of how immunotherapy can be used to treat such conditions as mesothelioma.
The immune system is the body’s protection mechanism. It is designed to defend against pathogens (microorganisms that can infect the body and cause disease) such as bacteria, viruses and toxins and to remove dead or damaged cells. The immune system basically tracks all the substances in the body and when it recognizes a substance that shouldn’t be there, it attacks it.
However, it is more difficult for the immune system to detect and kill cancer cells than germs or bacteria, because cancer cells and healthy cells have fewer differences. The immune system may not be strong enough to destroy the cancer or it may not see cancer cells as something foreign, which is where immunotherapy comes in.
Immunotherapy allows the body to recognize the cancer as foreign, allowing the body to specifically target and destroy cancer cells, while leaving noncancerous cells alone. This reduces side effects in comparison to standard treatment methods, such as chemotherapy, which affects all cells in the body, cancerous and noncancerous cells.
Immunotherapy is most successful when used in addition to standard treatments. Studies that have involved the use of immunotherapy and chemotherapy indicated a slight increase in survival rates. Research also shows a correlation in the enhancement of the immune system and pleural mesothelioma prognosis.
Introducing antigens into the body stimulates the immune system’s response to kill cancerous cells. 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 the treatment of pleural mesothelioma. Physicians inject the patient with antigenic substances that mimic the surface of the tumor cell. 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.
Using immune system components developed in a laboratory, such as man-made proteins, 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.
Immunotherapy has been making strides in the fight against cancer. The FDA has approved immunotherapy to treat some types of cancers, and it is now the focus of some mesothelioma clinical trials.
The targeted approach of immunotherapy helps healthy cells flourish, while the mesothelioma cells are targeted and destroyed. Standard treatments such as chemotherapy and radiation, target all cells in the body, resulting in side effects such as hair loss and vomiting. Without the aggressive natural of standard treatments, patients can experience less severe side effects.
Patients with later stages of mesothelioma may also be eligible to receive treatment because of the fewer side effects.
Whether immunotherapy is introduced with antigens or with laboratory components, it does have some side effects, which are the result of kick starting the immune system.
The most common side effects of immunotherapy include:
Amatuximab, a monoclonal antibody, is an immunotherapy drug and focus of some pleural mesothelioma clinical trials. Amatuximab (MORAb-009) targets and alerts the immune system to attack mesothelin, a protein found on the surface of pleural 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.
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.
There are multiple ways to achieve gene therapy:
Early clinical trials have shown that gene therapy can be safe and effective, but additional research is needed to perfect treatment techniques.
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.
The most common photosensitizer used to treat pleural mesothelioma is porfimer sodium, more commonly known as Photofrin. It is a drug that has been approved by the Federal Drug Administration (FDA) to treat other cancers, including esophageal cancer. Photofrin’s past success has helped show its potential and has allowed it to gain recognition as a FDA orphan drug, which helps it become approved to treat pleural mesothelioma.
In PDT, a doctor first injects a photosensitizer into the bloodstream of the patient. The drug is then absorbed by all the cells in the body; however 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 then targets specific areas with light to activate the drug, inducing a chemical reaction that kills the cancerous cells without damaging the healthy cells. For example, Photofrin reacts the best to red light. As a result, this pleural mesothelioma treatment has fewer side effects than standard chemotherapy.
Photodynamic therapy has shown the best results when used alongside surgery and as a multimodal treatment approach. In one study published in 2012, 38 pleural mesothelioma patients underwent a radical pleurectomy and intraoperative photodynamic therapy. In this study there was a median survival rate of 31.7 months for all 38 patients.
In a different study published in 2004, survival was extended by three to four months for patients who underwent surgery and received photodynamic therapy compared to those who were treated with surgery alone.
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 mesothelioma 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.
Our team of Patients Advocates can provide you free guidance throughout the process. Whether it's helping you select a pleural mesothelioma specialist or determining the best course of treatment, we are here to help.
Standard treatment options for pleural mesothelioma 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.
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 may be suggested as the primary treatment option for pleural mesothelioma patients 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 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.
If aggressive surgery or other potentially curative options is not recommended for someone with pleural mesothelioma, 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 pleural mesothelioma 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.
There are two palliative surgical options to treat a pleural effusion: Pleurodesis and thoracentesis. Both options remove fluid and relieve pressure on the lungs. A pleurodesis is often considered the better palliative treatment because it also closes the pleural space to prevent any further fluid buildup.
Although chemotherapy is generally used as a form of potentially curative treatment for pleural mesothelioma, it can also be used as a palliative treatment. The goal of palliative chemotherapy is to shrink the tumor to alleviate pain and other symptoms, as well as increase quality of life.
Radiation cannot cure pleural mesothelioma on its own, but it can be used solely as a palliative treatment. Palliative radiation can reduce the tumor size and alleviate chest pain caused by the tumor. It does have some side effects such as skin irritation and pleural effusion. If high dosages are used, pulmonary toxicity is also a possibility.