01. Cure Overview
Is Mesothelioma Curable?
There is currently no cure for mesothelioma. However, certain treatments may extend patient life expectancy and help achieve long-term remission.
Stage and type of cancer also play an important role in a mesothelioma patient’s prognosis. For example, diagnosis at stage 1 or stage 2 typically results in a more favorable outcome than late-stage diagnoses. Peritoneal mesothelioma also has a longer life expectancy than other types of mesothelioma.
In one study, researchers combined surgery and several types of chemotherapy treatment to achieve a median survival of 14.8 years in peritoneal mesothelioma patients. Another study found a median survival of 8.3 years with surgery and heated intraperitoneal chemotherapy (HIPEC). Other types of mesothelioma may not have as favorable of a prognosis.
Patients should keep in mind estimated survival times may be outlived. Pleural mesothelioma survivor Heather Von St. James was initially given 15 months to live. Heather has outlived her prognosis and is currently a 16-year survivor. She enjoys sharing her journey of treatment and survival with other mesothelioma patients.
02. Current Mesothelioma Treatments
What Are Some of the Most Promising Mesothelioma Treatments?
Promising mesothelioma treatments include surgery, chemotherapy, radiation and multimodal therapies. The success of any treatment will depend on a number of factors. These include stage at diagnosis, type of mesothelioma cancer and overall patient health.
Common Mesothelioma Treatments
Chemotherapy is a common treatment option for inoperable mesothelioma. In one study, pleural mesothelioma patients treated with chemotherapy alone had a median survival of 16.4 months.
This regimen consisted of a platinum chemotherapy drug combined with pemetrexed and gemcitabine. With this combination, researchers saw one of the most successful outcomes of mesothelioma treatment using chemotherapy alone.
Chemotherapy is also often used in multimodal treatments to achieve longer survival times.
Surgery is a common first-line treatment to reduce tumor mass. This is called cytoreductive surgery (CRS).
For mesothelioma, surgery on its own is not considered close to a cure. However, CRS is often included in successful multimodal treatment plans.
As a single treatment, one surgical option has proven superior to foregoing treatment. Pleurodesis is a surgery that helps prevent fluid buildup around the lungs. In one study, patients treated with pleurodesis had a median survival of 12 months.
Radiation is most often used in conjunction with other mesothelioma treatments. It is rarely used alone. It can also be used to treat cancer progression or as a palliative therapy.
In one study, patients with pleural or peritoneal mesothelioma underwent palliative radiation therapy. They had a median survival of about 12 months.
Immunotherapy can be combined with several therapies or used alone. It is also often used for patients who may not qualify for other therapies.
In one study, pleural mesothelioma patients received Keytruda®, an immunotherapy drug. These patients did not qualify for standard therapy. They had a median survival of 18 months.
It is important to receive treatment from a dedicated mesothelioma specialist. These doctors work in teams to create a mesothelioma treatment plan for each patient. These plans often use multimodal mesothelioma treatments to extend patient life expectancy.
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03. Multimodal Treatments Extend Survival
Multimodal Treatments Can Greatly Extend Survival
Combining treatments into multimodal therapies can yield high survival rates for mesothelioma patients. Some multimodal therapies have extended survival so long they may be considered functional cures. This means that while every cancer cell may not be eliminated, patients experience many years free of mesothelioma evidence and return.
Therapies with some of the longest observed median survival times for mesothelioma include:
- Pleural mesothelioma: In one study, a combination of chemotherapy, extrapleural pneumonectomy (EPP) surgery and radiation achieved a median survival of 39 months (3.25 years). The chemotherapy drugs used were Alimta®️ (pemetrexed) and cisplatin.
- Peritoneal mesothelioma: In one study, a combination of cytoreductive surgery and several chemotherapy treatments achieved a median survival of 14.8 years. The chemotherapy treatments used were heated intraperitoneal chemotherapy (HIPEC), early postoperative intracavitary chemotherapy (EPIC) and normothermic intraperitoneal chemotherapy (NIPEC).
Researchers continue to study multimodal therapies with the hope of improving patient prognosis.
04. Emerging Mesothelioma Treatments
Emerging Treatments for Mesothelioma
Emerging treatments such as gene therapy and Tumor Treating Fields provide promise in extending patient survival and improving prognosis. Researchers continue to test these treatments in clinical trials.
With continued study, these emerging and experimental treatments may become part of standard mesothelioma care and help progress the field towards a cure.
Immunotoxins are unique compounds that interrupt cellular processes necessary for survival. This interruption causes cells to die. Targeting immunotoxins to cancer cells can result in cancer cell death.
Researchers have achieved this goal with immunotoxin Pseudomonas exotoxin A. In one study, 11 mesothelioma patients were treated with this therapy. The patients had undergone a variety of prior treatments. Notably, a pleural mesothelioma patient in the study experienced a 74% reduction in tumor volume. This patient’s tumor reduction had held steady at the 15-month follow-up. Researchers are now investigating this technology in larger studies.
Tumor Treating Fields (TTFields)
TTFields are a new therapy using mild electric stimulation to disrupt cell division and slow or stop cancer cell growth. One study tested TTFields in 80 pleural mesothelioma patients. After treatment, 72 patients received follow-up scans. In this group, 40% saw tumor shrinkage and 57% saw their tumors stop growing.
In 2019, the U.S. Food and Drug Administration (FDA) approved a TTFields system called Optune Lua™ for use against unresectable pleural mesothelioma.
Herpes Simplex Virus (HSV)
This treatment uses a modified herpes virus to attack cancer cells. This type of treatment is known as oncolytic virus therapy. Patients are injected with HSV-1716, a modified form of HSV. HSV-1716 can infect and kill cancer cells. However, it cannot survive in healthy cells, leaving them intact.
A British study examined HSV therapy for mesothelioma. The study included 11 patients with epithelial mesothelioma. Two patients with unknown mesothelioma cell types also participated in the study. Researchers found 46% of patients in the study achieved disease stability, with no tumor growth. This means researchers observed no tumor growth as of the last study follow-up.
Gene therapy uses bioengineering techniques to alter the DNA of cells. In one study, gene therapy emerged as a potentially promising treatment for patients ineligible for surgery. Researchers altered the DNA of pleural cells to produce interferon-alpha protein. This protein can slow cancer cell growth and help the immune system kill cancer cells.
Some study patients received the chemotherapy drug pemetrexed before and after gene therapy. These patients had a median survival of 26 months.
Many small molecule drugs can enter a patient’s cells easily due to their low molecular weight. Researchers have investigated the small molecule ganetespib against pleural mesothelioma. Ganetespib interferes with several important cellular functions. It was tested in combination with pemetrexed and platinum-based chemotherapy as a first-line treatment. Patients who received the maximum tolerated dose of ganetespib achieved a median survival of 16.3 months.
Recent Breakthrough in Mesothelioma Research Provides Hope
In October 2020, the FDA approved an immunotherapy treatment combination for pleural mesothelioma. This was the first FDA approval for a systemic pleural mesothelioma treatment in over 15 years.
The newly approved first-line treatment combines Opdivo®️ (nivolumab) and Yervoy®️ (ipilimumab). This combination is a promising option for pleural mesothelioma patients who are not eligible for surgery. The approval came after a large study documented the treatment’s success. The researchers found a median survival of 18.1 months for pleural mesothelioma patients who received the immunotherapy duo.
Research on these treatments is ongoing. Some mesothelioma cancer patients may be able to participate in clinical trials, though eligibility requirements vary. Interested patients should talk to their doctor. A mesothelioma expert can help patients determine the best treatment approach for their unique situation.
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05. Ongoing Mesothelioma Treatment Research
Ongoing Research to Find a Mesothelioma Cure
Research on new methods of mesothelioma cancer treatment provides hope for a mesothelioma cure one day. Researchers also continue to test standard treatments. Continuing to study conventional therapies can have many positive outcomes, including:
- Extending patient survival
- Helping to manage treatment side effects
- Improving patient quality of life
- Improving quality of cancer care
The National Cancer Institute (NCI) is one of the foremost centers in the fight against cancer. It is an independent research institution established by the U.S. government in 1937. The NCI receives funding and disperses it to universities, hospitals, labs and other research institutions. Many clinical trials around the country are run by the NCI or NCI-designated cancer centers.
Clinical trials are especially important to improve treatment and detection methods. Early detection is one of the most important areas of research in the fight against mesothelioma. By detecting the signs of cancer early, mesothelioma doctors can help prevent progression. One promising area of early detection research is biomarkers.
Biomarker Research May Be Promising for Early Detection
Biomarkers are physical and objective indicators, which may be used to identify cancerous and precancerous cells before they spread. Researchers have identified a few promising biomarkers for mesothelioma:
- ENOX2: In 2016, study researchers tested serum samples from asbestos-exposed individuals for biomarker ENOX2. The researchers were able to correctly identify mesothelioma in 17 asbestos-exposed individuals several years prior to symptom manifestation. Further study is needed to determine if this biomarker would be viable on a larger scale.
- Mesothelin: Mesothelin is a protein found on normal mesothelial cells as well as a variety of cancer cells, including mesothelioma. Over several studies, researchers found elevated levels of mesothelin in the blood of 15 – 40% of asbestos-exposed individuals. These results came before they were diagnosed with mesothelioma. The mesothelin test MESOMARK™ is currently the only FDA-approved mesothelioma test. However, it is not sufficient for diagnosis on its own.
- HMGB1: HMGB1 is a protein that is released into the bloodstream when asbestos-exposed cells die. Some researchers have called HMGB1 the “most powerful circulating single-molecule diagnostic to date.” However, HMGB1 has not been widely tested enough to confirm this claim yet.
Researchers continue to conduct clinical trials to study biomarkers. In addition to early detection, studies are being conducted to test different combinations of current treatments.
Upcoming Mesothelioma Clinical Trials
This trial will investigate a complex form of immunotherapy. Pleural mesothelioma patients will receive a dendritic cell vaccine. The vaccine will help immune cells target and kill mesothelioma cancer cells. Patients will also undergo platinum and pemetrexed chemotherapy. Researchers estimate the study will conclude in December 2024.
This trial will study an immunotoxin called LMB-100. Patients will undergo up to two cycles of LMB-100 treatment with Yervoy (ipilimumab). Patients may then receive two additional rounds of ipilimumab. Researchers estimate the study will conclude in November 2025.
Obstacles for Mesothelioma Researchers
Emerging and experimental cancer treatments provide hope for mesothelioma patients. However, there are still obstacles to mesothelioma research and treatment.
One of the biggest hurdles in treating mesothelioma is the rarity of the disease. Only a few thousand people are diagnosed with mesothelioma annually in the United States. This rarity can prevent awareness and adequate sample sizes for research. It can also impact funds for research. Mesothelioma research receives less research funding than more common cancers, such as lung cancer and breast cancer.
Despite these challenges, mesothelioma researchers continue to pursue new treatments.