Mesothelioma Treatment & Therapy

How is mesothelioma treated?

Treatment of Mesothelioma cancers using conventional therapies has not proved successful. Patients have average survival time of between 6 - 12 months after presentation of the cancer. Normally, the clinical behaviour of the cancer’s malignancy is affected by some important factors including the continuous mesothelial surface of the pleural cavity which favours treatment through local metastasis via exfoliated cells, invasion to underlying pleural tissue and other organs within the pleural cavity, and the extremely long delay period between asbestos exposure and development of the disease.


Surgery

With Mesotheliom cancers, surgery, in itself or used in conjunction with pre- and/or post-operative treatments has proved to get disappointing results with a 5 year survival rate of less than 10%, amongst the lower quadrants of the cancer survivor matrix.

The most common surgeries are pleurectomy/decortication, in which the lining of the chest is completely removed, thus removing the malignant cancers too. Less common is an extrapleural pneumonectomy, in which the afflicted lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed altogether. Unfortunately, it is not possible to remove the entire mesothelium without killing the patient.


Radiation
It should be noted that Mesothelioma cancers are very resistant to radiation therapy. Although the tumor is highly resistant to radiotherapy, these regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Generally these treatments are used as a secondary course of action rather than the primary which makes it differ from the therapies of other types of cancer.

The course of radiotherapy is commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.


Chemotherapy

In February 2004, the Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given to the patient in combination with cisplatin. The side-effects of pemetrexed can be quite strong and Folic acid is also used to reduce its severity.


Immunotherapy


Treatment regimens involving immunotherapy have mixed results, some patients respond very well while others not at all. For example, intra-pleural inoculation of Bacillus Calmette-Guérin in an attempt to boost the immune system response to the cancer was found to be of no benefit to the patient, where this treatment generally works very well.

On the other hand, Mesothelioma cancer cells proved to be susceptible to in-vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major negative side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia.

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.