The most effective way to beat mesothelioma is also the simplest and quickest: Pull the disease out of your body.
That statement is why mesothelioma surgery is connected to long-term survival. If you can remove the mesothelioma tumors, then your body becomes significantly healthier. Even if you can’t remove all of them, extracting a majority could be a life-saver.
Also a life-saver? Not waiting to have the surgery.
A recent study published in the Journal of the National Cancer Institute discussed why surgery is ideally the first treatment used for pleural mesothelioma. Before radiation. Before immunotherapy. Even before chemotherapy.
The study compared using immediate resection versus waiting and using chemotherapy before surgery. The results show why promptly undergoing surgery is the best approach for pleural mesothelioma.
What Is Neoadjuvant Chemotherapy?
Neoadjuvant chemotherapy refers to chemotherapy given prior to the primary curative treatment, which is usually surgery.
For pleural mesothelioma, the two curative surgeries are extrapleural pneumonectomy and pleurectomy with decortication. Most mesothelioma specialists prefer using chemotherapy after performing one of these surgeries (this is called “adjuvant chemotherapy”).
Chemotherapy before surgery can have advantages for patients with advanced-stage mesothelioma. Doctors use neoadjuvant chemotherapy to:
- Stall the cancer’s spreading
- Shrink the size of tumors
- Reduce how much space the disease takes up within the body
For many patients, the mesothelioma tumors have duplicated too much and spread too far to be removed at once. Many late-stage mesothelioma patients undergo neoadjuvant chemotherapy in hopes of reducing the size of the disease, making them a candidate for surgery.
However, for most people with mesothelioma, neoadjuvant chemotherapy just delays receiving the life-extending treatment they desperately need.
Study Shows Benefits of Immediate Mesothelioma Surgery
Chemotherapy treatment usually lasts months. Is it beneficial to wait as many as three months before removing a large chunk of the tumors? The latest study says “no.”
The researchers in the study analyzed pleural mesothelioma cases from Duke University Medical Center and the National Cancer Database (NCD). They specifically looked for patients who either received neoadjuvant chemotherapy before mesothelioma surgery or had surgery immediately.
In the Duke University arm of the study, 127 patients underwent immediate surgery and 130 had chemotherapy first. Their overall survival times were similar, but researchers found that neoadjuvant chemotherapy led to a higher risk of postoperative mortality.
In the NCD cohort, 1,597 patients had immediate surgery and 352 had chemotherapy before surgery:
- The average survival for the immediate surgery group was 19 months.
- The average survival for the neoadjuvant chemotherapy group was 16 months.
- Similar to the Duke University cohort, the neoadjuvant chemotherapy group had an increased risk of postoperative mortality.
The researchers concluded that neoadjuvant chemotherapy “was associated with worse post-resection survival” compared to immediate surgery.
What Are the Drawbacks to Neoadjuvant Chemotherapy?
The results of the study leave one lingering question: Why doesn’t neoadjuvant chemotherapy work as well as immediate surgery? The researchers addressed this topic in their report.
First, using chemotherapy before surgery doesn’t always decrease the size of mesothelioma tumors or how far they’ve spread:
- Of the patients who underwent neoadjuvant chemotherapy in the study, only 20% had tumor response (meaning the disease reduced in size).
- The other 80% either had disease growth or stable cancer (meaning it neither shrank nor grew).
“As a result, patients who received surgery delated by (neoadjuvant chemotherapy) may experience disease progression, and consequently decreased survival following surgery, which we observed in both our institutional and NCD cohorts,” the report stated.
A second explanation is that chemotherapy can weaken the body, which becomes more vulnerable to issues arising during or after surgery. Chemotherapy has numerous effects, including:
- Anemia (low red blood cell count)
- Weakened muscles
If a patient undergoes multiple months of chemotherapy, then their body may not be strong enough to endure surgery. Since chemotherapy kills very little — if any at all — of this cancer, the risk of weakening the body may outweigh the reward.
“We know from feasibility studies that only 70-75% of patients who undergo (neoadjuvant chemotherapy) are able to proceed with surgical resection,” the report states.
How to Proceed in Treating Your Mesothelioma
The standard pleural mesothelioma prognosis, when not appropriately treated, is usually a few months or a maximum of two years. Undergoing an immediate and successful pleural mesothelioma surgery can extend your survival time by multiple years — and even decades.
We can help you find a mesothelioma surgeon and take steps to plan your treatment. Our Doctor Match program is a free resource to learn which specialists are best for your diagnosis.
If you’d rather speak with a medical expert immediately, then our registered nurse Jenna Campagna is available to talk. Please email her at firstname.lastname@example.org at your earliest convenience.
Show Sources & Author
- The Role of Neoadjuvant Chemotherapy in Patients with Resectable Malignant Pleural Mesothelioma – An Institutional and National Analysis. Journal of National Cancer Institute. Retrieved from:
https://www.deepdyve.com/lp/ou-press/the-role-of-neoadjuvant-chemotherapy-in-patients-with-resectable-AMKn0oSv6j. Accessed: 04/01/2020.
- Is Neoadjuvant Chemotherapy in Malignant Pleural Mesothelioma Beneficial? Cancer Therapy Advisor. Retrieved from:
https://www.cancertherapyadvisor.com/home/cancer-topics/lung-cancer/malignant-pleural-mesothelioma-beneficial-neoadjuvant-chemo/. Accessed: 04/01/2020.