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Important Facts to Know About Mesothelioma Remission
- Remission is a sign that treatment is working and cancer is shrinking. It’s a positive sign for patients undergoing radiation, chemotherapy or immunotherapy.
- Mesothelioma remission is not always permanent. Some patients are in remission for a few months and then the cancer begins to spread again.
- Being in remission for a long amount of time – such as 5-10 years – means you’re a survivor and potentially cured of mesothelioma.
- Doctors shy away from using the word “cure” with mesothelioma remission due to how mesothelioma spreads as tiny tumors, which sometimes hide in places not seen on imaging tests.
What Is Remission?
Remission means the signs of cancer are reducing. Remission in cancer might mean tumors are smaller than they were previously, or they’re completely gone. Doctors can tell if you’re in cancer remission based on imaging scans, such as a CT scan or PET scan.
There is partial remission and complete remission. Partial remission means the cancer is showing up on scans but the tumors are smaller. Complete remission means there are no more signs of cancer on scans.
Defining Remission in Mesothelioma Cancer
Mesothelioma remission follows these definitions. When mesothelioma tumors are smaller than at the time you were diagnosed and tumors aren’t showing in as many areas, it is said to be in partial remission.
Sometimes mesothelioma can be managed for years in a state of partial remission. Managing mesothelioma, as well as achieving remission and preventing relapse, is possible due to maintenance therapy like immunotherapy and targeted therapy in clinical trials.
When doctors can no longer detect the presence of mesothelioma, it is said to be in complete remission. Mesothelioma doctors tend to prefer this definition instead of the word “cure” because, although they may not be able to detect cancer with current testing methods, the disease may still be present in undetectable amounts.
Any chronic disease with the potential to relapse, or begin spreading again, is called “incurable.” There are many mesothelioma survivors who have lived long, full lives once their mesothelioma went into remission. Some of these survivors have lived for a decade or more. This offers hope to current and future patients hoping to achieve mesothelioma remission.
After you reach remission, follow-up appointments are essential to ensure the cancer stays in remission. The frequency of these appointments varies with each patient but more visits are usually required if you had a more serious diagnosis.
The frequency of doctor appointments also goes down as more time passes with no signs of recurrence. For example, following successful surgery, you’ll likely have follow-up appointments every few months. This will change to an appointment once every six months and eventually an annual appointment with your primary doctor or specialized mesothelioma oncologist.
Stories of Mesothelioma Remission
The goal for all patients is to achieve remission of their disease. Although mesothelioma typically has a short prognosis compared to other types of cancer, many patients have beat the odds and achieved remission. Read stories of how mesothelioma survivors have reached remission in our free Mesothelioma Survivor’s Guide.
Which Treatments Offer the Best Hope of Mesothelioma Remission?
Mesothelioma survivors attribute many different treatments to the remission of their cancer. These treatments range from surgery to successful clinical trials testing new therapies or combinations.
The treatment for mesothelioma offering the greatest chances of complete, long-term remission is surgery, especially when used in combination with immunotherapy, chemotherapy or radiation therapy. Chemotherapy and immunotherapy are the next best options when surgery isn’t possible due to the patient’s age, health, or stage of mesothelioma. Both can cause partial remission for patients and extend their lives by precious and meaningful months.
Radiation therapy alone rarely causes remission. It has little effect on life expectancy and is typically reserved for the most advanced diagnoses. Radiation is a palliative therapy to try and slow the growth of cancer and relieve patients of symptom pain.
Mesothelioma Remission Chances by Treatment
- Surgery: Most Successful. All visible tumors are physically removed from the body.
- Chemotherapy: Moderate Success. Chemotherapy kills cancerous cells, but can damage healthy cells.
- Immunotherapy: Moderate Success. Immunotherapy makes the immune system stronger to fight cancer while not injuring healthy tissue.
- Radiation Therapy: Least Successful. On its own, radiation therapy helps to slow the growth of cancerous cells, but can also harm healthy tissue.
- Clinical Trials: Circumstantial. The type of clinical trial and success causing remission is based on each case, such as cell type, stage, age and treatment history.
Surgery has the best odds of leading to remission of mesothelioma. During mesothelioma surgery, tumors are completely removed before they can spread through the lymphatic system and reach other organs. Surgery can remove most or all of the tumors at one time improving the ability to reach remission, in most cases, with the help of other treatments like chemotherapy and immunotherapy.
There are three surgeries for mesothelioma. Each initiated a move towards remission in many patients and have produced survivors. They are:
- Extrapleural pneumonectomy (EPP) for pleural mesothelioma
- Pleurectomy/decortication (P/D) for pleural mesothelioma
- Cytoreductive surgery with HIPEC for peritoneal mesothelioma
Some patients who had an EPP survive upwards of 19 months, P/D patients live for 2-3 years, and those having cytoreductive surgery with HIPEC often live 3-5 years after the procedure.
Chemotherapy for mesothelioma has come a long way since its initial development. Chemotherapy wasn’t very effective when it was first used for mesothelioma, but now there are several new chemotherapy drugs and drug combinations that have a strong effect on mesothelioma tumors. The two main chemotherapy drugs are cisplatin and pemetrexed. Carboplatin, vinorelbine and gemcitabine are alternatives.
Patients often have a partial remission from chemotherapy, but the tumors eventually grow resistant to the drugs. Remission only lasts a few months for most patients.
Furthermore, the inception of intraoperative chemotherapy with surgery has produced promising results for mesothelioma remission, especially for peritoneal mesothelioma patients. Intraoperative chemotherapy for peritoneal mesothelioma is called HIPEC.
Immunotherapy is the newest type of FDA-approved treatment for mesothelioma. Opdivo and Yervoy are approved for unresectable mesothelioma. These are cases that cannot be treated with surgery.
Opdivo and Yervoy for mesothelioma have a median survival of 18-19 months when used on their own. Opdivo is the brand name for nivolumab and Yervoy is the brand name for ipilimumab. Other immunotherapy drugs are Keytruda (pembrolizumab) and Imfinzi (durvalumab).
Immunotherapy is also an option in clinical trials before or after surgery. Mesothelioma specialists believe the best chance of achieving cancer remission is with multimodal therapy. Immunotherapy is a useful part of multimodal treatment plans. When surgery removes the tumors, immunotherapy can prevent the cancer from returning.
Similar to chemotherapy, immunotherapy can lead to partial or even complete mesothelioma remission. However, the remission often only lasts a few months.
Radiation therapy is another traditional treatment method for all types of cancer. Unfortunately, on its own, radiation therapy is unlikely to generate mesothelioma remission. However, multimodal therapy that combines radiation therapy with surgery or chemotherapy has shown significant strides towards causing remission in mesothelioma patients.
Novel Therapies and Clinical Trials
While the efficacy of novel treatments generally require more research to fully realize their potential, there are several current clinical trials offering novel treatments offering hope to patients. These novel therapies include treatments such as virotherapy and gene therapy.
The FDA approved a tumor treating fields device called NovoTTF-100L, or Optune Lua. This device is considered maintenance treatments in the event surgery isn’t an option, and they outperform chemotherapy in clinical studies.
CAR T-cell therapy is one of the leading cell and gene therapies in clinical trials for mesothelioma. CAR T-cell therapy led to complete remission and long-term survival for blood cancer patients.
This therapy has yet to duplicate the success for solid tumors like mesothelioma. However, many studies use CAR T cells that target the protein mesothelin, which is expressed on nearly all mesothelioma cells. The breakthroughs in blood cancers mean there is a possibility of achieving a complete mesothelioma remission for some patients.
At some point, even the most trusted treatment methods were novel, so patients shouldn’t limit themselves to traditional treatments if their cancer is advanced and a novel treatment holds the possibility of remission.
Mesothelioma survivor Kendra Ferreira participated in clinical trials responsible for the remission of her disease. If you have been diagnosed with mesothelioma and are exploring treatment options, pursue recruiting clinical trials.
Recurrence After Cancer Remission
Reappearance of mesothelioma after remission is an unfortunate but real possibility. Therefore, chronic diseases like mesothelioma should be treated as an ongoing disease that requires constant management. This ongoing treatment and constant management means regular surveillance testing, doctor appointments, and possibly restarting chemotherapy or immunotherapy treatments that worked previously.
You or your family member with mesothelioma should be diligent about checkups and recognizing symptoms associated with this cancer. If a relapse occurs, this doesn’t mean all hope is gone. Any patient who achieved remission once can surely do it again with the help of mesothelioma doctors, nurses and cancer center staff.
Contact our team for help finding a cancer center or doctor to learn more about mesothelioma remission. We can also help if you’ve had a recurrence. Reach out to patient advocate Karen Ritter, who is a registered nurse, by email at firstname.lastname@example.org. You can also contact her with this link to send a message directly to her or another patient advocate.
Sources & Author
- NCI Dictionary of Cancer Terms. National Cancer Institute. Retrieved from: https://www.cancer.gov/publications/dictionaries/cancer-terms?CdrID=45867. Accessed: 10/15/18.
- When Cancer Doesn’t Go Away. American Cancer Society. Retrieved from: http://www.cancer.org/treatment/survivorship-during-and-after-treatment/when-cancer-doesnt-go-away.html. Accessed: 10/15/18.