Mesothelioma Treatment: Options, Surgery & Emerging Therapies
Mesothelioma is treated with chemotherapy, immunotherapy, radiation and surgery. Doctors often treat pleural patients with a chemo and immunotherapy combination and peritoneal patients with tumor-removing surgery and HIPEC. Multimodal approaches combining treatments yield the best survival outcomes.
Expertise
Mr. Wasserberg is proud to call himself a Trial Lawyer. He is often a featured speaker at industry summits and gatherings of the nation’s leading attorneys, from both sides of the bar. He is recognized by both his peers and his adversaries and is considered one of the nation’s premier mesothelioma and negligence attorneys
Content written by Dan Wasserberg
- Expertise
Mr. Wasserberg is proud to call himself a Trial Lawyer. He is often a featured speaker at industry summits and gatherings of the nation’s leading attorneys, from both sides of the bar. He is recognized by both his peers and his adversaries and is considered one of the nation’s premier mesothelioma and negligence attorneys
Experienced Mesothelioma Attorney
First-Line Treatments for Mesothelioma
First-line treatments for mesothelioma are the FDA-approved therapies considered gold standard and typically given first when someone is diagnosed with mesothelioma. While first-line treatment can be a single therapy, it often involves a combination of therapies that are most effective together.
If you’ve received a mesothelioma diagnosis, your care team will customize a plan for you from these first-line treatments that take specific details about your health into account. The right approach for you depends on the type of mesothelioma you have, the stage or progression of the cancer and your overall health.
Your doctors will look at whether tumors began in the chest (pleural mesothelioma) or the abdomen (peritoneal mesothelioma) to guide their choice. Different treatments are considered gold standard for each type of mesothelioma.
Chemotherapy
Chemotherapy uses drugs to kill fast-growing cancer cells throughout the body. It can be used alone, before surgery to shrink tumors or after surgery to kill any remaining cells.
- Alimta (pemetrexed) + cisplatin: This is the most common FDA-approved combination for pleural mesothelioma. It’s often the standard first-line choice.
- Alimta (pemetrexed) + carboplatin: This is an alternative for patients who may not tolerate cisplatin well. Carboplatin is a related drug that can have fewer side effects for some patients.
Chemotherapy is often given in cycles of periods of treatment and then periods of rest. While it can cause side effects like fatigue, your care team has ways to help manage and support you through treatment.
Immunotherapy
Immunotherapy helps your own immune system recognize and attack cancer cells. It is a standard of care for pleural mesothelioma and an active area of research for peritoneal mesothelioma.
- Opdivo (nivolumab) + Yervoy (ipilimumab): This is an FDA-approved immunotherapy combination for pleural mesothelioma. It’s given as an IV infusion and enhances your immune system (T-cell activation).
Opdivo with Yervoy restores the body’s natural antitumor immune response, allowing the immune system to recognize and attack mesothelioma cells more effectively. - Keytruda (pembrolizumab): This drug is FDA-approved for certain solid tumors, including mesothelioma, that haven’t responded to other treatments. It’s also being studied in clinical trials as a first-line option.
For pleural mesothelioma, immunotherapy is now a powerful first-line option with chemotherapy. For peritoneal mesothelioma, researchers are working to find the best ways to use these drugs through clinical trial testing.
Radiation Therapy
Radiation uses high-energy beams to destroy cancer cells in a specific area. It’s a targeted therapy, which treats a precise location to help control tumor growth and manage symptoms.
- Intensity-modulated radiation therapy: A precision form of radiation, IMRT shapes the beams to match the tumor. This helps protect healthy tissue like the lungs and heart, making it a key treatment for pleural mesothelioma.
- Stereotactic body radiation therapy: SBRT delivers very high doses of radiation in just a few treatments. It’s used for small, isolated tumors or to treat areas where cancer has spread.
- Palliative radiation: Lower doses of radiation are used to shrink tumors that are causing pain and trouble breathing or swallowing.
Radiation is most commonly used for pleural mesothelioma, especially after surgery to target any remaining cancer cells. It’s used less often for peritoneal mesothelioma because the cancer can spread throughout the abdomen, making it hard to target without harming healthy organs.
Surgery
Mesothelioma surgery removes visible tumors. It’s a major procedure, so not everyone is a candidate. Doctors consider your overall health, your cancer type and how far it’s spread before recommending surgery.
- Cytoreductive surgery with HIPEC: CRS is the standard surgical approach for peritoneal mesothelioma. The surgeon removes all visible tumors from the abdomen and then a heated chemo bath, HIPEC, washes the abdomen to kill any remaining cancer cells.
- Extrapleural pneumonectomy: EPP is an aggressive surgery for pleural mesothelioma. It removes the affected lung, part of the lining around the heart, the diaphragm and the lining of the chest wall.
- Pleurectomy with Decortication: P/D surgery for pleural mesothelioma removes the lining of the lung and chest wall but leaves the lung intact. This can result in faster recovery time and fewer risks than an EPP.
Surgery is often a central part of a multimodal plan for those who qualify. Patients with the epithelioid mesothelioma cell type and those whose cancer hasn’t spread widely are often good candidates. Your care team will run tests to check if your body is strong enough to handle the procedure.
What Is Multimodal Mesothelioma Care?
Multimodal care is a treatment plan that combines two or more types of therapy. Instead of using one approach, doctors use a combination to attack the cancer from different angles. This is increasingly the standard for patients who are healthy enough to undergo multiple treatments.
- Immunotherapy + chemo: This combination is a first-line standard for pleural mesothelioma. The chemo kills cancer cells while the immunotherapy helps the immune system find and attack any remaining cells.
- Surgery + chemo: This is a common approach for both pleural and peritoneal mesothelioma. For pleural cases, chemo may be used before surgery to shrink tumors or after to treat any remaining cancer cells. For peritoneal mesothelioma, HIPEC is delivered directly into the abdomen during surgery.
- Tumor treating fields + chemo: TTFields is a therapy that uses a portable device to create low-level electrical fields that can disrupt cancer cell division. It’s FDA-approved for pleural mesothelioma to be used at the same time as chemo.
Bringing these different treatments together requires a team of specialists. The goal is to maximize the impact on the cancer while carefully managing your health and recovery. This coordinated approach often leads to better outcomes than a single treatment alone.
New and Emerging Mesothelioma Treatments
Researchers are constantly looking for new ways to treat mesothelioma. These emerging therapies offer hope for more effective options, especially for patients who haven’t responded to standard treatments. Most are still being studied in clinical trials.
- Cancer vaccines: Unlike common vaccines that prevent disease, these are treatments designed to train your immune system to find and attack mesothelioma cells. They’re personalized to a patient’s specific cancer.
- CAR-T cell therapy: This therapy takes a patient’s own immune cells, modifies them in a lab to better recognize the specific cancer cells and then infuses them back into the body. It’s shown promise for some solid tumors and is being explored for mesothelioma.
- Gene therapy: This approach changes the genetic DNA inside cancer cells. It introduces new genes to make cancer cells more sensitive to chemo or to help healthy cells better resist the effects of treatment.
These therapies are exciting areas of active research. While they’re not yet standardized or FDA-approved, they represent the ongoing effort to find better treatments. For patients, joining a clinical trial can be a way to access these new options while contributing to medical knowledge and progress.
How to Join a Mesothelioma Clinical Trial
Clinical trials are research studies that test newly designed treatments. For mesothelioma, they’re a way to access the latest cutting-edge care. Participating in a clinical trial is an opportunity to be part of advancing treatment.
- Talk to your care team. Ask your oncologist if they know of any trials you might qualify for as a candidate. They can help you understand if a trial fits with your treatment goals.
- Connect with a patient advocate. Organizations that support people with mesothelioma often have advocates who can help search for trials based on your diagnosis, stage and location.
- Contact the trial team. Once you find a potential trial, the research coordinator will explain the process, the risks and benefits and what would be required of you during the treatment.
- Review and enroll. Take your time to understand the consent form. Ask questions. If it feels like the right step for you, enroll and begin the screening process.
The path to joining a trial involves several steps, but it starts with a simple question to your doctor. They can help you see if this path is right for you.
Palliative Care and Curative Therapies: What's the Difference?
Palliative care focuses on managing symptoms like pain, shortness of breath and fatigue to improve your quality of life. It’s not the same as hospice care. Palliative care can be given at any time during treatment, even while you’re receiving curative therapies aimed at stopping the cancer.
- Drainage procedures: For pleural mesothelioma, a procedure called a thoracentesis can drain fluid from around the lungs to make breathing easier. For peritoneal mesothelioma, a paracentesis drains fluid from the abdomen.
- Nerve blocks: These are injections that can block pain signals from a specific area, providing relief without the side effects of oral pain medicine.
- Pain medicines: These include over-the-counter pain relievers as well as stronger prescription medications to manage pain from tumors or from treatment side effects.
Many of the same procedures used in palliative care can also be part of a curative treatment plan. The key takeaway is that seeking help for symptoms doesn’t mean you’re giving up on treatment. It means you’re taking an active role in maintaining your strength and well-being throughout your cancer journey.
How Do Doctors Determine Eligibility for Mesothelioma Treatments?
Doctors don’t recommend the same treatments for every person. They look at several factors to determine which therapies are most effective, safe and have the fewest side effects. It can help to bring prepared questions about these factors with you when you speak to your doctor about your personalized treatment plan.
- Cancer stage: How far the cancer has spread is a key factor. People with early-stage cancers that are still contained are usually good candidates for surgery. Later-stage cancers that have spread may be treated with systemic therapies like chemo or immunotherapy.
- Cell type: Mesothelioma has three main cell types. Epithelioid responds better to treatment and is often considered for surgery. Sarcomatoid can be more aggressive and may guide doctors toward different options. Biphasic is a mix of the other two cell types, and treatment often depends on which is more dominant.
- Overall health and fitness: Your age, heart and lung function, and general strength, play a huge role for surgery fitness. Doctors use tests to see if your body can safely handle aggressive procedures.
- Prior treatment history: If you have already had one type of treatment and it stopped working, that will influence what doctors recommend next. They’ll look for a different approach that can target cancer in a new way.
These criteria are tools doctors use to match the right treatment to the right person. Asking your doctor, “What factors are most important in my case?” can help you understand the reasoning behind their recommendations.
Mesothelioma Treatment FAQs
Is mesothelioma curable?
Currently, there is no cure for mesothelioma. However, treatments have improved survival significantly. For some people, especially those diagnosed early, aggressive multimodal therapy can lead to long-term control of the cancer, with many living for years after treatment. The goal of treatment is often to manage the disease, extend life and maintain a good quality of life.
Is mesothelioma treatment different for pleural, peritoneal, pericardial and testicular mesothelioma?
Treatment is very different depending on tumor location. Pleural mesothelioma (chest) is the most common and has established standards like immunotherapy and surgery. Peritoneal mesothelioma (abdomen) is often treated with a specialized surgery called CRS with HIPEC. Pericardial (heart lining) and testicular mesothelioma are extremely rare, and their treatment is usually based on the treatments used for pleural and peritoneal cases (surgery).
What happens if first-line treatment stops working?
Your doctor will discuss second-line options. This might mean trying a different chemo or immunotherapy. Joining a clinical trial for an emerging therapy may also be an option. Your care team will re-evaluate your current health status and the cancer’s behavior to find the next best step.
If I don’t qualify for surgery, what are my other treatment options?
Many effective non-surgical treatments exist. Your doctors may recommend a combination of chemo and immunotherapy as a first-line approach. Radiation can be used to target specific tumors, and palliative procedures can help manage symptoms. These non-surgical paths can be very effective in controlling the disease and maintaining your quality of life.
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