Standard treatments for malignant mesothelioma include surgery, chemotherapy and radiation. Treatment plans may incorporate a combination of the three, if possible for the patient. For cases where standard treatments do not work, mesothelioma patients may be able to participate in clinical trials to try experimental treatments.
There is no cure for mesothelioma, but it is possible for treatment to improve patient prognosis. Treatment options will vary based on the type of mesothelioma, patient characteristics and staging. For late-stage patients, there are alternative therapies and palliative care options that can help improve symptoms and quality of life.
Standard Mesothelioma Treatments
When determining which treatment type is best for the patient, mesothelioma doctors will consider mesothelioma type, cell type and patient characteristics. The patient’s age and overall health may limit what treatment options are viable. The stage of cancer is also an influential factor. If the disease is localized, more treatment options are available than if spreading has occurred.
In many cases, mesothelioma specialists will recommend a multimodal approach, which combines surgery, chemotherapy and/or radiation therapy, or even emerging treatments in some cases. In various studies, multimodal treatment has been shown to be more effective than any of the individual treatments alone. In particular, surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC), a heated chemotherapy wash applied directly to the abdominal cavity, has demonstrated around a 50% survival rate or higher for peritoneal mesothelioma patients in recent clinical studies. With aggressive multimodal plans, patients should be aware of all potential treatment side effects.
When conducting a multimodal treatment plan, doctors will refer to treatments as neoadjuvant, primary or adjuvant. The three types of treatments are determined based on the order that they are performed.
- Neoadjuvant therapy: Used before the primary treatment to shrink or reduce tumor size (commonly radiation or chemotherapy).
- Primary treatment: The main treatment type, used to remove as much of the cancer as possible (commonly surgery).
- Adjuvant therapy: Treatment performed after the primary treatment to kill remaining cancer cells (commonly chemotherapy).
Clinical Trials and Experimental Treatments
Researchers and specialists continue to make advances in mesothelioma research, with efforts towards finding a cure and more effective treatment options. Before a treatment becomes approved by the U.S. Food and Drug Administration (FDA) and readily available to all patients, it’s considered an experimental treatment and only offered through clinical trials. Experimental treatments have the potential to become a standard care option if proven successful.
Malignant mesothelioma patients must meet certain criteria in order to be eligible to participate in a clinical trial. In most cases, emerging treatments are designed for patients that are in the late stages of their diagnosis and/or if the cancer is not responding to standard treatment options. Emerging treatments may be able to extend life expectancies for patients, however, patients still must meet other criteria specific to the trial, which can include a particular type and cell type, stage of disease or prior treatments received. Ultimately, patients should discuss their options with their mesothelioma doctor to understand eligibility.
Immunotherapy has been shown to be successful in treating mesothelioma and other diseases by boosting the immune system. Used on its own or when combined with standard treatments like chemotherapy, immunotherapy has shown promising success in the treatment of mesothelioma, in some cases extending life expectancy by months or even years.
The effectiveness of different immunotherapy drugs continues to be tested, particularly when used during a multimodal treatment plan. Types of immunotherapy that have been used include:
- Adoptive cell therapy
- Cancer vaccines
- Checkpoint inhibitors
- Monoclonal antibodies
Gene therapy is another emerging treatment that has shown promise in treating malignant mesothelioma for some patients. Gene therapy works by repairing the genetic structure or function of cells. If repair is successful, it can potentially treat the disease or help prevent the development of diseases without as many side effects as treatments like chemotherapy or radiation therapy. Types of gene therapy include:
- Gene transfer
- Genetic virotherapy
- Oncolytic viruses
Mesothelioma Doctors and Cancer Centers
Not all physicians have experience treating mesothelioma cancer. There are mesothelioma doctors around the United States who have experience treating the disease with extensive knowledge regarding the best treatment options, new treatment advances and palliative care to potentially extend patient survival and improve quality of life. Some mesothelioma experts specialize in particular types of the disease. Thoracic oncologists specialize in cancers of the chest with expertise specific to pleural mesothelioma and pericardial mesothelioma. Some specialize particularly in peritoneal mesothelioma.
If a patient is diagnosed with malignant mesothelioma, they’ll likely be referred by their primary health care physician to a larger scale comprehensive cancer institute. Comprehensive cancer centers will be able to provide the most up-to-date cancer treatments, as well as access to different clinical trials. Cancer centers are located throughout the country, and many are linked to top medical universities.
Palliative Mesothelioma Treatments
Palliative mesothelioma treatments may be used on their own or in conjunction with standard treatment options. These treatments aren’t used to treat the cancer, but rather to improve symptoms and quality of life for patients.
Common palliative treatments include pleurocentesis and paracentesis, which are used to drain excess fluid buildup around the lungs or abdomen. This helps alleviate symptoms associated with the fluid buildup, including chest or abdominal pain, difficulty breathing and shortness of breath.
Palliative treatments can be invasive or non-invasive, including anything from pain medication to physical therapy, massage, acupuncture, yoga and other alternative therapies. Mesothelioma patients may undergo palliative care during their treatment journey, as their sole treatment plan during the late stages of their diagnosis or after treatment.
No matter what type of treatment patients pursue, they should discuss all options with their medical care team to understand what is best for their individual case. This can also provide an idea of potential treatment costs for financial planning and decision-making.
Author: Linda Molinari
Editor in Chief, Mesothelioma Cancer AllianceRead about Linda
Reviewer: Dr. James Stevenson
Medical Reviewer and Thoracic Medical OncologistRead about Dr. Stevenson
Bakker E, Guazzelli A, et al. Immunotherapy advancements for mesothelioma treatment. Expert Review of Anticancer Therapy. 2017;17(9):799-814. doi: 10.1080/14737140.2017.1358091
Kindler HL, Ismaila N, et al. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. An American Society of Clinical Oncology Journal. 2018;36(13):1343-1373
Ryu JW and Kim YS. A Case of Advanced Malignant Pleural Mesothelioma Treatment with Chemotherapy and Photodynamic Therapy. Tuberculosis and Respiratory Diseases. January 2015; 78(1):36-40. doi: 10.4046/trd.2015.78.1.36
Perrot MD, Wu L, et al. Radiotherapy for the treatment of malignant pleural mesothelioma. The Lancet: Oncology. September 2018;18(9):e532-e542. doi: 10.1016/S1470-2045(17)30459-X