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Mesothelioma Treatment Options
While there is currently no cure available for malignant mesothelioma, there are treatments available. Deciding what options are best for your means finding a mesothelioma doctor you can trust and coming up with the best treatment plan for your unique situation.
The Stages of Mesothelioma Treatment
How mesothelioma is treated depends on where the cancer is, how far it has spread, and the patient's age and general health. Some typical treatments are as follows:
Localized Malignant Mesothelioma (Stage I)
If the cancer is only in one place in the chest or abdomen, treatment will probably be surgery to remove part of the pleura and some of the tissue around it.
If the cancer is found in a larger part of the pleura, treatment may entail one of the following:
- Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
- Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
- External beam radiation therapy to relieve symptoms.
- A clinical trial of surgery followed by chemotherapy given inside the chest.
- A clinical trial of surgery, radiation therapy, and/or chemotherapy.
Advanced Malignant Mesothelioma (Stages II, III, and IV)
For advanced malignant mesothelioma, treatment may be one of the following:
- Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.
- Surgery to relieve symptoms.
- Radiation therapy to relieve symptoms.
- Chemotherapy.
- A clinical trial of surgery, radiation therapy, and chemotherapy.
- Chemotherapy given in the chest or abdomen.
Recurrent Malignant Mesothelioma
Treatment depends on many factors, including where the cancer came back and what treatment the patient received before. Clinical trials are testing new treatments.
Traditional Mesothelioma Treatments
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Surgery:
- A common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed. Depending on how far the cancer has spread, a lung also may be removed. This operation is called pneumonectomy.
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Radiation therapy:
- Using high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
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Chemotherapy:
- Using drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).
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Intraoperative photodynamic therapy:
- A new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.
Novel and New Mesothelioma Treatments
Outlined below are some of the new treatments being developed for asbestos-related disease and cancers:
Photodynamic Therapy
This form of treatment uses highly focused light to kill cancer cells. The patient receives a drug called a photosensitizer which builds up in cancerous cells but not in healthy cells. The photosensitizer drug causes cells to be sensitive to light of specific wavelengths. Once the cancer cells have become sensitized, surgery is performed in order to place fiberoptic cables in the body. This enables the focusing of light of the correct frequency on the tumor. This process causes the photosensitizer drug to produce toxic oxygen molecules which kill the cancerous cells. This treatment has been used successfully to combat other types of cancer and, hopefully, it will be just as successful in the fight against mesothelioma.
Immunotherapy
Immunotherapy utilizes the body's immune defense system to combat cancer cells. There are various therapies currently being tested that fall into this category.
Gene Therapy
This is a new therapy where a "suicide gene" is implanted inside the tumor, making the cancer cells sensitive to drugs that are normally ineffective in fighting cancer. When administered, the drugs kill only the cancer cells, and the healthy cells are not harmed. This allows doctors to concentrate the treatment on the tumor only, as opposed to treatments like chemotherapy that kill cancerous and healthy cells alike.
Cytokines
Cytokines are proteins that effect the behavior of other cells. One type of cytokine molecule is called interleukin - 2 (IL2). IL2 causes immune system cells to grow. These cells, called T-cells, are also referred to as killer cells because they kill cancerous cells. Scientists theorize that injecting IL2 into the pleura of the lung will result in the death of the cancerous cells in the pleura. This treatment is now in the experimental stage but provides hope for the future.
Interferons
Interferons are cytokine proteins that act to enhance the body's immune system. Interferons stop the rapid growth of cancerous cells and, at the same time, increase the body's ability to fight off the malignant cells. Experiments are currently being conducted to see if interferons will combat the aggressive mesothelioma tumors.
Experimental Chemotherapy
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L-NDDP
- This is a new chemotherapy protocol that is being tested at the New York University Kaplan Cancer Center in New York City. (212) 263-8043 kccc-www.med.nyu.edu/mesoletter. Chemotherapy involves the use of toxic chemicals to kill cancer cells. L-NDDP is a compound that is administered directly into the pleura of the lung. The compound is cleared very slowly from the pleural cavity and, therefore, has more time to unleash its toxic effects on the tumor. This agent has also been found to effectively penetrate tumors by virtue of its creamy composition. L-NDDP has been found to be less toxic to the body than conventional chemotherapy drugs. Clinical trials with L-NDDP are currently being conducted at the Kaplan Cancer Center on patients with mesothelioma and the early results have been promising.
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Onconase
- Onconase is a new chemotherapy drug that is currently being tested in clinical trials. Onconase is a ribonuclease protein that promotes the anti-cancer effects of traditional chemotherapy. With conventional chemotherapy drugs, the body removes the drug from cancer cells. This results in the administration of high doses of the drugs in order to kill the cancer cells. Experiments have shown that Onconase causes cancer cells to be more susceptible to lower doses of toxic drugs. The administration of lower doses of toxic drugs that are still effective has the benefit of reducing the side effects of the treatment.
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