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For a newly diagnosed mesothelioma patient, the flood of disease and treatment information that follows can be difficult to process. While you can trust that your doctor will have your best interests in mind when developing your treatment plan, it’s still a good idea to be an active patient and understand the standards of care for mesothelioma.
What is Standard of Care?
Standard of care is a guideline for medical treatment that depends on the type of patient, illness, and/or clinical conditions. To determine standard treatments for different diseases, a group of physicians agree on and establish guidelines based on scientific research for treating patients with a specific type and stage of a disease. Medical professionals review the evaluated treatments and recommend one or a combination that provides the best chances of and longest survival.
For mesothelioma patients, standard of care can involve surgery, chemotherapy, radiotherapy, or a combination of two or three types of treatments, known as multimodal therapy.
Chemotherapy Standard of Care
One of the most widely used treatments for mesothelioma is chemotherapy, so its standard of care is important to know and understand.
The current standard of care in chemotherapy uses a combination of pemetrexed, a drug also known as Alimta, and the drug cisplatin. This combination is the most studied treatment option for patients with malignant pleural mesothelioma.
The benefits of this combination chemotherapy treatment are measured in two ways. The first measure is the length of time the chemotherapy blocks the growth of mesothelioma, also known as progression-free survival. The progression-free survival of patients treated with pemetrexed and cisplatin ranged from 3.4 months1 to 7.2 months2 to 9.5 months.3
The second measure is the duration of survival and is called the median overall survival. The median overall survival of patients with mesothelioma ranges from 12.8 months1 to 19.9 months.2
In addition, patients treated with chemotherapy maintained their quality of life longer than those treated with best supportive care, reporting less pain for 16 weeks.4
Other Potential Standard Treatment Options
Other agents and procedures are being tested for their ability to improve control and killing of mesothelioma compared to the chemotherapy standard of care. Several cancer centers have reported that treating peritoneal mesothelioma (mesothelioma throughout the abdomen) with a combination of chemotherapy and surgery had notable results, where implementing regular or warm (hyperthermic) chemotherapy after surgically removing the larger nodules improved responses.5
Another study reported that cytoreductive surgery, the combination of surgery and radiation, followed by local administration of chemotherapy improved 5-year survival in peritoneal mesothelioma patients up to 63%.5
Immunotherapy, or treatment using parts of a person’s immune system to fight disease, is another treatment area that is showing promise for mesothelioma patients. Recently, studies of immunotherapy treatments involving drugs like pembrolizumab, also known as Keytruda, and bevacizumab have shown positive and promising results to improve a treated patient’s prognosis.
How to Choose a Treatment Plan
Before deciding on a treatment plan, sit down with your doctor to discuss your health history, the stage of your disease, and your options for the best quality of life. If you are in good health overall and can carry out your normal daily activities, you may be able to have a more aggressive treatment plan than a patient in poor overall health.
Patients with a poorer health status may be limited in their options because of the toxicity of the treatments. In these cases, patients should thoroughly discuss the treatment options and weigh the risks and benefits with their physicians and family. Some patients opt for supportive care or palliative care, which uses lower doses of chemotherapy or other types of treatment to ease the symptoms.
Treating Individual Patients
It’s important to note that the treatment of each patient has a unique set of challenges—the patient’s goals, the health status, other health conditions all need to be considered before deciding on a course of action.
This is why it is important for the patient and their family to understand and discuss the risks and benefits of the proposed treatments for your specific type and stage of mesothelioma with their healthcare team. Ultimately, the patient and family should be part of the decision-making team.
Krug LM, Wozniak AJ, Kindler HL et al. Randomized phase II trial of pemetrexed/cisplatin with or without CBP501 in patients with advanced malignant pleural mesothelioma. Lung Cancer 2014;85(3):429-434.
Shukuya T, Takahashi T, Imai H et al. Comparison of cisplatin plus pemetrexed and cisplatin plus gemcitabine for the treatment of malignant pleural mesothelioma in Japanese patients. Respir Investig 2014;52(2):101-106.
Lainakis G, Zagouri F, Kastritis E et al. Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience. Tumori 2011;97(1):25-29.
Arnold DT, Hooper CE, Morley A et al. The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial. Br J Cancer 2015;112(7):1183-1189.
Mirarabshahii P, Pillai K, Chua TC, Pourgholami MH, Morris DL. Diffuse malignant peritoneal mesothelioma--an update on treatment. Cancer Treat Rev 2012;38(6):605-612.