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Important Facts About Pleural Mesothelioma Treatment
- The best approach in pleural mesothelioma cases is multimodal treatment, which involves a combination of different treatment therapies, including surgery.
- There are additional treatment options for pleural mesothelioma still in testing through clinical trials.
- Pleural mesothelioma treatment is constantly evolving with new treatment methods, which helps more patients receive effective treatment, increasing survival.
Pleural Mesothelioma Treatment Options
Pleural mesothelioma treatment options can vary depending on the patient and the stage of their cancer. Mesothelioma is treated with surgery, medications and various therapies. There are additional treatment options for pleural mesothelioma being studied through clinical trials.
The primary options for pleural mesothelioma treatment are surgery, chemotherapy, immunotherapy, and radiation. Surgery is the best treatment option to improve pleural mesothelioma survival. Chemotherapy, immunotherapy and other therapies may be provided as standalone treatments or in combination with surgery.
Most mesothelioma specialists prefer to use a combination of treatment options. One treatment may target a certain area of cancer that another cannot reach. Combining treatment methods can increase the chances for effective results.
Although there is no cure, pleural mesothelioma can be treated. The main focus of pleural mesothelioma specialists is to provide each patient with the best treatment options for their specific needs.
Pleural mesothelioma surgery is one of the best treatment options to increase survival. Surgery allows the mesothelioma surgeon to actually see the cancer and physically remove tumors along with affected organs and tissues. However, not all pleural mesothelioma patients are candidates for surgery.
There are two surgery options: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).
Extrapleural Pneumonectomy (EPP)
Extrapleural pneumonectomy (EPP) is the most aggressive type of pleural mesothelioma surgery. During this surgery the affected lung is removed along with the pleura, the lining around the lung. If the cancer has spread further than the lung, surgeons may opt to remove the pericardium, the sac around the heart, and part or all of the diaphragm.
Pleurectomy With Decortication (P/D)
Pleurectomy with decortication (P/D) was developed by mesothelioma specialists as an alternative to EPP. This surgery removes the pleura and, if necessary, the pericardium and part of the diaphragm. Removing the pleura is a way to remove the majority of the mesothelioma tumors and diseased tissue while keeping the lungs intact.
Chemotherapy for pleural mesothelioma is the most commonly used treatment method. This type of treatment can be an option before, during or after surgery, even in cases when surgery is not an option. It can also be combined with immunotherapy and radiation.
Pleural mesothelioma chemotherapy is a cancer-killing treatment method. The goal is to target cells growing and dividing faster than usual, such as cancer cells. One of the side effects is chemotherapy can kill healthy tissue cells as well, leading to nausea, fatigue and low hemoglobin.
Pemetrexed and cisplatin are the FDA-approved pleural mesothelioma chemotherapy drugs.
Immunotherapy for pleural mesothelioma is an FDA approved treatment option. The goal of immunotherapy is to boost the immune system’s ability to fight off foreign invaders, like cancer cells, in a natural way similar to how the immune system fights off viruses.
There are several different types of immunotherapy for mesothelioma. The most commonly used form of immunotherapy is checkpoint inhibition.
Yervoy and Opdivo are two FDA-approved checkpoint inhibitor immunotherapy drugs for pleural mesothelioma treatment. The FDA approved Opdivo and Yervoy to be used together in cases when patients are not candidates for surgery.
The FDA also approved Keytruda for pleural mesothelioma immunotherapy. Keytruda is the brand name of the checkpoint inhibitor immunotherapy drug pembrolizumab.
Immunotherapy drugs are also the subject of many clinical trials. With continued research, additional immunotherapy treatment options may be available in the future.
Radiation therapy is a treatment option primarily for pleural mesothelioma. It is most effective when used in combination with other treatment methods, such as before or after surgery.
Pleural mesothelioma radiation is a noninvasive and painless procedure. The process of radiation treatment is similar to receiving an X-ray imaging scan. Radiation machines send high-energy beams into the chest cavity to target pleural mesothelioma tumors. Side effects of radiation may include fatigue, nausea and skin irritation.
There are a few types of radiation for pleural mesothelioma: intensity-modulated radiation and proton beam radiation. Radiation is often combined with other therapies (surgery, chemotherapy and immunotherapy) and rarely used on its own, aside from palliative treatment.
Multimodal therapy for pleural mesothelioma involves the use of multiple therapies to improve life expectancy as much as possible. The goal of multimodal therapy is to attack cancer cells in various ways.
When treatments are administered back to back, they enhance the effects of the individual therapy. The most common therapies used in multimodal treatment are surgery, chemotherapy, immunotherapy and radiation.
In 2019, the FDA approved Optune Lua (NovoTTG-100F System) as a pleural mesothelioma treatment. Optune Lua creates tumor treating fields, or electrical fields, to disrupt cell division in cancer cells.
This wearable device produces low-intensity electric fields at a medium frequency that target tumors in the chest cavity. The interruption in cell division can cause cancer cells to be destroyed, shrinking tumors and minimizing the spread of mesothelioma.
While this is a non-invasive option, it is not without its side effects. Optune Lua must be worn for 23 hours a day, it is necessary to carry the device pack with you at all times and can cause skin irritation.
Palliative care is a type of pleural mesothelioma treatment with the goal of improving patient quality of life. The primary methods to improve quality of life are by reducing pain from symptoms, mental and physical distress, and the fear of dying.
Improving patient quality of life is achieved by draining fluid buildup, reducing chest pressure, and supporting the patient and caregiver psychosocial needs. Palliative care should be a top priority throughout the treatment of mesothelioma.
Pleural mesothelioma clinical trials are medical studies used to test experimental treatment approaches. They offer patients the opportunity to receive innovative therapies or treatments that have not been approved by the FDA.
Clinical trials usually take place at cancer centers and top-ranking hospitals. They often benefit patients with late-stage mesothelioma or patients who have failed other treatments.
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Frequently Asked Questions About Pleural Mesothelioma Treatment
Can You Treat Pleural Mesothelioma?
Yes, pleural mesothelioma treatment can be treated in several ways. There are a few different pleural mesothelioma surgery options and various therapies, such as chemotherapy, immunotherapy and other emerging treatment options.
How Do You Treat Pleural Mesothelioma?
Pleural mesothelioma is often treated with surgery, such as extrapleural pneumonectomy (EPP) or pleurectomy with decortication (P/D). EPP is more aggressive as it removes the pleura and affected lung. P/D spares the lung, primarily removing the pleura. Other treatment options are chemotherapy, radiation, tumor treating fields and immunotherapy.
What Treatment Options Are Available to Patients with Advanced Stage Pleural Mesothelioma?
Many mesothelioma patients are not diagnosed until it’s already in advanced stages, such as stage 3 or 4. Due to the advanced stage of the cancer, surgery or other therapies may not be an option. In these cases, doctors offer palliative care or pain management, which involves draining fluid buildup, relieving tumor tension, and reducing symptoms.
Sources & Author
- Sex Differences in Risk of Severe Adverse Events in Patients Receiving Immunotherapy, Targeted Therapy, or Chemotherapy in Cancer Clinical Trials. Journal of Clinical Oncology. Retrieved from: https://ascopubs.org/doi/full/10.1200/JCO.21.02377. Accessed: 02/18/2022.
- Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D). Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497106/. Accessed: 12/07/2020.
- Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: An Analysis of 2000 Patients From the National Cancer Database. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32006127/. Accessed: 07/08/2020.
- Chemotherapy for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/chemotherapy.html. Accessed: 02/09/2021.
- Malignant pleural mesothelioma: adjuvant therapy with radiation therapy. Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497112/. Accessed: 02/28/2020.
- Consensus Statement on Proton Therapy in Mesothelioma. Practical Radiation Oncology. Retrieved from: https://www.practicalradonc.org/article/S1879-8500(20)30117-X/pdf. Accessed: 06/10/2020.
- What Is IMRT? Memorial Sloan Kettering Cancer Center. Retrieved from: https://www.mskcc.org/cancer-care/diagnosis-treatment/cancer-treatments/radiation-therapy/what-imrt. Accessed: 02/09/2021.
- Intraoperative radiation therapy (IORT). Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/intraoperative-radiation-therapy/about/pac-20385150. Accessed: 02/09/2021.