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Individuals who receive a diagnosis of malignant pleural mesothelioma have many options for treatment.
Treatments available for mesothelioma can include drugs, chemotherapy, surgery, and radiation treatment. Some patients may choose to explore their options for alternative therapies, including photodynamic therapy, hormone therapy, and experimental treatments.
Often, a mixture of treatments is used in order to target different aspects of the disease and provide the best chances of improving the patient’s overall prognosis. This is referred to as a multimodal therapy approach.
Determine the Optimal Treatments by Speaking with a Medical Professional
Speak with your oncologist to determine the best approach or mixture of approaches to treat your condition. This treatment plan should be customized according to your specific diagnosis, the development of the cancer, case details, personal medical factors, and your own preferences.
The therapies available for mesothelioma will respond differently to each patient case, making it important to educate yourself on the available options, monitor your responsiveness to treatment, and adjust your treatment plan as part of an ongoing dialog with your team of physicians — as well as with those who support you in your life. Make sure you are informed as to the possible side effects and pros/cons of each treatment option before coming to a medical decision.
Unfortunately, malignant pleural mesothelioma is a rare and aggressive form of cancer that can be difficult to treat.[1] Detecting the cancer early can broaden your available treatment options and potentially improve your prognosis, but know that many treatment programs aim to alleviate symptoms and improve 5-year survival chances rather than seek the possibility of complete remission.
There is also no universal consensus on the optimal treatment protocol for mesothelioma in general given the rarity of the diagnosis and the variability of patient presentations.[2]
Common Mesothelioma Treatment Options
The following are the main categories of options for treatment available to those with a malignant pleural mesothelioma diagnosis:
- Surgery
- Chemotherapy
- Other cancer drugs
- Anti-Angiogenesis drugs
- Immunotherapy
- Targeted therapy
- Radiation therapy
- Photodynamic therapy
- Hormone therapy
- Alternative treatments
These treatment options are described, in brief, below in order to provide an introduction as to how they work and how they intend to treat the various conditions that can arise from pleural-based malignancy.
You will find additional information in the sections that follow these brief descriptions, which offer a more in-depth explanation for the most-common surgical procedures, chemotherapy treatments, and other types of anticancer drugs.
None of the information in this guide constitutes medical advice, but it does provide an educational resource that can encourage further exploration and selection of your available treatment options with the help of a qualified medical team.
Surgical Options for Malignant Mesothelioma
The most common common surgical procedures used to treat malignant pleural mesothelioma attempt to remove — or resect — the malignant tissue before it has a chance to grow and spread. Resective surgery is most successful when patients can receive an early diagnosis where the cancer is at stage I, stage II, or possibly even stage III.[3]
Resective surgery for mesothelioma is highly invasive, meaning that the body will have difficulty recovering. Individuals with compromised immune system or suppressed vital signs may not be ideal candidates for surgery given the stress it places upon the body. However, patients who have an early diagnosis or an easily identifiable tumor can achieve a favorable prognosis through surgical intervention alone.[4]
Some surgical or medical procedures intend to alleviate symptoms rather than treat the cancer directly, such as draining fluid from the pleura to alleviate pressure upon the lungs. These are referred to as palliative procedures.
Chemotherapy
Chemotherapy most often refers to the use of powerful drugs that can kill fast-growing cells within the body.[5] They are used against cancer cells since they can inhibit their rapid growth.
However, chemotherapy drugs can also harm or suppress healthy cells within the body, causing a range of side effects that can include fatigue, weakness, or immunosuppression.
Various drug options are available to treat different types of cancer cells or states of progression. Each has their set of effective uses as well as potential side effects.
Other Cancer Drugs
There are cancer drugs for just about every letter of the alphabet.[6] They may target the cancer cells directly, or they may help alleviate some of the side effects caused by the condition.
Common non-chemotherapy drugs for mesothelioma include: anti-angiogenesis drugs, immunotherapy drugs, and targeted therapy drugs.
Anti-Angiogenesis Drugs
Angiogenesis inhibitors, often called anti-angiogenesis drugs, interfere with the body’s ability to develop new blood vessel tissues. This type of treatment can be effective when targeted at cancer cells since tumors must stimulate the growth of blood vessels in order to grow and survive past a few millimeters.
Some of the angiogenesis inhibitors approved to treat cancer include:
- Axitinib (Inlyta)
- Bevacizumab (Avastin)
- Cabozantinib (Cometriq)
- Lenalidomide (Revlimid)
- Ramucirumab (Cyramza)
- Sorafenib (Nexavar)
- Thalidomide (Synovir, Thalomid)
- Vandetanib (Caprelsa)
- Ziv-aflibercept (Zaltrap)
Immunotherapy
Immunotherapy drugs can directly aid the immune system in fighting cancer cells. These drugs can slow the growth of tumors, prevent their spread, or in some cases enable the body to fight off cancer cells entirely on its own.[7]
Checkpoint inhibitor drugs remove the biological barriers that prevent T cells from attacking or impeding the growth of cancer cells.
Adoptive cell transfer therapy is a type of immunotherapy that removes T cells found attacking tumor cells in order to cultivate the most effective versions of them, which are injected back into the bloodstream.
Patients can also receive injections of monoclonal antibodies, cytokines, or cancer treatment vaccines, which can improve the body’s ability to combat cancer cells.
Targeted Therapy
Unlike chemotherapy drugs, targeted therapy drugs can affect cancer cells largely without hurting the other healthy cells in your body. Instead, they interfere with cancer cell growth directly, helping reduce the growth and spread of tumors while killing some cancer cells directly.
Types of targeted therapy drugs used for mesothelioma include angiogenesis drugs and immunotherapy drugs.
Radiation Therapy
Radiation therapy uses high doses of x-rays or radioactive particles to directly kill cancer cells.
Radiation treatment can kill masses of cancer cells, shrink existing tumors, or reduce the spread of cancer by killing off smaller, less robust cells. At the same time, the radiation damages other healthy cells it makes contact with, often causing weakness, fatigue, and a range of other side effects.[8]
Since malignant pleural mesothelioma is often distributed across the surface of the pleura, it can be difficult to treat the condition through radiation therapy alone, compared to other forms of cancer with more-localized tumor growth.[9] As such, radiation therapy for malignant mesothelioma is typically used after surgery to kill areas of small cancer growth or as a palliative measure to reduce the size of cancer cells that cause symptoms such as trouble swallowing.
Photodynamic therapy
Photodynamic therapy (PDT) for mesothelioma involves injecting photosensitizing drugs into cancer tissues. When these chemicals are exposed to light, they trigger the release of a specific form of oxygen that can kill nearby cells.[10] After injection, physicians wait 24 to 72 hours to wait for most of the photosensitizer to be removed from healthy cells, while cancer cells tend to absorb and hold onto the chemicals longer. The tissues are then exposed to lights of various wavelengths, triggering the desired reaction.
Because the light radiation energy used in PDT can only penetrate a few millimeters of skin, it is most effective when used in the thoracic region of the body, meaning the chest and lungs. The procedure has shown promise for treatment of non-small cell lung cancer (NSCLC), and it holds potential for treating malignant pleural mesothelioma, especially in combination with resective surgery.[11],[12]
Hormone Therapy
Women have a significantly lower rate of developing mesothelioma compared to men[13], and they also have a 5-year survival rate that is three times higher.[14] A number of recent studies have hypothesized that hormone differences could be a factor in addition to epidemiological differences like occupational trends.[15]
Specifically, the female body’s higher concentrations of oestradiol and progesterone are hypothesized to have a possible anti-cancer effect against mesothelioma cancers.[16] These potential effects are being studied in clinical trials and experimental therapies.
However, it should be noted that the use of hormone replacement therapy to increase the levels of estrogen plus progestin have been shown to increase the risk of certain types of lung cancer.[17]
Alternative Treatments Available for Malignant Pleural Mesothelioma
The field of oncology is the subject of perpetual and vigorous research, which means that there are many clinical trials and experimental therapies available to those who are willing.[18] These unapproved therapies lack the benefit of having fully known results, effectiveness, best practices, or adverse side effects, but they may also prove beneficial compared to other treatments available.
Additionally, the field of alternative medicine provides remedies that can address the symptoms of cancer while possibly even aiding the body in its ability to fight off cancer cells.
Alternative remedies used to address cancer symptoms or boost immune capabilities include:
- Acupuncture
- Massage
- Meditation
- Hypnosis
- Aromatherapy
- Music therapy
- Yoga
- Tai chi
- Diet changes
- Exercise
[1] https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/survival-statistics.html
[2] https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-treatment
[3] https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html
[4] https://www.medscape.com/viewarticle/724140
[5] https://www.mayoclinic.org/tests-procedures/chemotherapy/about/pac-20385033
[6] https://www.cancer.gov/about-cancer/treatment/drugs
[7] https://www.cancer.gov/about-cancer/treatment/types/immunotherapy
[8] https://www.mayoclinic.org/tests-procedures/radiation-therapy/about/pac-20385162
[9] https://www.cancer.org/cancer/malignant-mesothelioma/treating/radiation.html
[10] https://www.cancer.gov/about-cancer/treatment/types/surgery/photodynamic-fact-sheet
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272687/
[12] https://www.ncbi.nlm.nih.gov/pubmed/21348586
[13] https://www.cancer.org/cancer/malignant-mesothelioma/about/key-statistics.html
[14] https://www.annalsthoracicsurgery.org/article/S0003-4975(14)00824-8/pdf
[15] https://www.sciencedaily.com/releases/2014/02/140226101821.htm
[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491202/
[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849773/
[18] https://thorax.bmj.com/content/69/2/194
