Combination of Surgery and Chemotherapy Still Recommended for Epithelioid Mesothelioma

Even with the rise of immunotherapy as an effective treatment option for mesothelioma, the combination of surgery and chemotherapy remains the recommended multimodal treatment approach for the aggressive cancer.

A study published in the Journal of Thoracic Disease noted the benefits for patients with epithelioid mesothelioma who received systemic chemotherapy before or after surgery. The findings showed how surgery plus chemotherapy improves the survival of patients compared to receiving other therapies or combinations.

Chemotherapy and surgery are two of the top treatment options for mesothelioma. Others are immunotherapy and radiation therapy.

 

Survival Data for Surgery and Chemotherapy

The study included 3,534 patients with epithelioid mesothelioma, which is one of the three mesothelioma cell types. Epithelioid mesothelioma is typically more responsive to treatments, and patients with this cell type are more likely to be candidates for surgery. 

The patients in the study were in stage 1, stage 2, or stage 3, which are the stages of mesothelioma when surgery is considered to be an option. Stage 4 is generally too advanced for surgery.

Of the patients included, only 677 (19%) received the recommended multimodal treatment combination of surgery and chemotherapy. The median survival for this group was 2 years (24.7 months), compared to just 13.7 months for the other 2,857 patients who did not receive the guideline approach. The 5-year survival rate was 17.7% for the surgery-and-chemotherapy group, and only 8% for the other group.

 

Surgery for Mesothelioma

There are a few aggressive surgeries for mesothelioma. The one that doctors choose to perform depends on the type of mesothelioma and where it has formed in the body.

For pleural mesothelioma, which forms in the lining of the lungs, the two surgery options are pleurectomy with decortication and extrapleural pneumonectomy. Pleurectomy with decortication removes the lining of the lungs along with part of the diaphragm. Extrapleural pneumonectomy removes the diseased lung, the lining around the lung and part of the diaphragm, making it the more radical of the two operations.

For peritoneal mesothelioma, which forms in the lining of the abdominal cavity, the surgery option is cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC). Cytoreduction is a debulking operation where doctors remove visible tumors along with any diseased tissue linings or non-vital organs in the abdominal cavity (such as the spleen). HIPEC is an intraoperative heated chemotherapy administered during cytoreductive surgery.

 

Chemotherapy for Mesothelioma

Chemotherapy for mesothelioma is usually administered systemically, meaning through an IV and into the bloodstream. The two FDA-approved chemotherapy drugs for mesothelioma are pemetrexed and cisplatin. Patients receive these chemotherapy drugs together.

For patients who have an adverse reaction to cisplatin, they can substitute it for the chemotherapy drug carboplatin.

 

No Difference in Survival for Neoadjuvant or Adjuvant Chemotherapy

Some researchers and doctors have studied whether it’s best for patients’ survival to use chemotherapy before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy).

In the study, nearly half of the 677 received chemotherapy before surgery and the other half received it after their operation. The median survival was similar – 24.9 months for chemotherapy before surgery and 24.5 months for chemotherapy after surgery.

This data is interesting and emphasizes the importance of using surgery with chemotherapy regardless of the order. Mesothelioma cancer centers of excellence offer this multimodal approach for patients with resectable mesothelioma tumors.

If you have been diagnosed with mesothelioma and wish to learn about your treatment options, please contact our registered nurse and patient advocate Karen Ritter. She’s available via email at karen@mesotheliomaguide.com.