Howard (Jack) West, M.D.

In my second video podcast, I explain the side effects that a mesothelioma patient can expect when administered chemotherapy treatments. Cisplatin and Alimta® are the two most commonly used chemotherapy drugs and often a combination of the two drugs is given. If you or a loved one is about to undergo chemotherapy, I hope this information is useful in helping you prepare for your upcoming treatments.

In my first video podcast, I answer the common question from malignant pleural mesothelioma patients about both the possible benefits and harm that can result from taking non-prescribed vitamins and supplements during treatment. While many patients believe that taking more vitamins and supplements means better health, I'll explain that more is not always better when it comes to recommending alternative therapies for patients undergoing treatment.

Among the many challenges in treating malignant pleural mesothelioma (MPM) is the limitation we have in not really being able to do larger, randomized trials easily, particularly in the small subset of patients who are really strong candidates for more aggressive treatment options (like surgery, which is typically a big procedure even by the standards of lung surgery.) The most aggressive protocols involve a sequence of chemotherapy, surgery, and chest radiation. What these studies tend to show is that there are certainly some patients who do extremely well after the most aggressive “multimodality therapy” for MPM. But do they do well because of the aggressive therapy or because they qualified for it?

This morning in our thoracic oncology tumor board discussion, we reviewed a case of a 72 year-old man who is now diagnosed with malignant pleural mesothelioma (MPM) that is too advanced to consider surgery, and who is rather debilitated from emphysema and other longstanding medical problems. The best studied treatment for MPM is the chemotherapy combination of cisplatin and Alimta (pemetrexed), which has a proven survival benefit compared with cisplatin alone1. But cisplatin is an older chemotherapy agent that is notoriously challenging for even many fit patients to tolerate. This raises the question of whether there might be an alternative approach for patients who are unlikely or unwilling to tolerate the anticipated side effects of a cisplatin/Alimta combination, which often include nausea/vomiting, possible kidney damage, hearing loss, peripheral neuropathy (numbness and tingling from nerve damage), and sometimes other issues not typically seen with carboplatin. The data from a large European registry2 provide reassurance that the generally better tolerated combination of carboplatin/Alimta can provide comparable benefit for patients who are not candidates for the standard cisplatin-based regimen.

Among the many challenges of managing malignant pleural mesothelioma (MPM) is reliably assessing the response of the disease to our treatment. We don’t want to discard a treatment that is effective, nor do we want to have patients continue on a treatment that isn’t helpful but is causing significant side effects. In oncology, we typically grade our work by comparing an imaging study like a computerized tomography (CT) scan of the chest done after 2-3 cycles of systemic therapy (usually covering a 6-9 week interval) to a baseline scan performed prior to the start of treatment. As you’d suspect, significant tumor shrinkage is good, while growth is bad, and stable disease is somewhere in between. Typically, we want to continue our treatment in the absence of significant progression or prohibitive side effects.

Hi, folks.

My name is Dr. Jack West, and I’m a medical oncologist specializing in thoracic oncology at Swedish Cancer Institute in Seattle, WA. Over the next year, I’ll be covering a broad range of topics related to malignant pleural mesothelioma; one of the cancers I treat, as well as speak and write about for the cancer community. Though it’s a relatively uncommon cancer in the US and around the globe, my corner of the country actually has the highest per capita incidence of mesothelioma. This is primarily because of the many shipyards in our area where people are exposed to asbestos, and our center has emerged as one of the leading places in the country for management of mesothelioma.