Mesothelioma Treatment Options

Mesothelioma is an aggressive disease that often requires an equally aggressive treatment strategy. However, mesothelioma is resistant to many standard cancer treatments, making it a difficult disease to manage.

Most often a mesothelioma treatment plan consists of chemotherapy. For patients who are candidates, surgery and radiation will also be used in a multi-modal approach. Patients should work closely with their medical team to develop a treatment plan that is tailored to their needs and treatment goals.

Even though there is no cure for mesothelioma, treatment strategies are referred to as either curative or palliative in intent. Our mesothelioma lawyers can help you find the best treatment options.

Curative treatments attempt to cure or control the disease, while palliative care is aimed at relieving symptoms and keeping the patient comfortable and surrounded by loved ones without treating the cancer itself.

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Cure for mesothelioma includes:

Surgery

Not all patients are good candidates for surgery. In addition to the patient’s general health, the stage and type of disease help drive the oncologist’s decision to operate. The two primary curative surgeries for mesothelioma patients are pleurectomy/decortication and extrapleural pneumonectomy (EPP).

• Pleurectomy/decortication (P/D). This surgery is sometimes referred to as the “lung-sparing” surgery. The surgery involves stripping away the diseased membrane lining the lung and visible mesothelioma tumors while saving the lung.
• Extrapleural pneumonectomy (EPP). EPP is the alternative to P/D for pleural mesothelioma patients. This surgery is considered a more radical procedure that involves removal of a lung, the diseased lining of the chest cavity and heart, and a portion of the diaphragm.

Palliative surgical procedures focus on relieving symptoms that are impacting a patient’s quality of life, but they do not focus on curing the cancer. Debulking pleurectomy and pleurodesis are two procedures often used in conjunction to improve the breathing for a patient. The pleurectomy eases pressure on the lungs by stripping cancer cells from the pleura. A pleurodesis is then performed to fuse the pleura and limit fluid build-up.

Chemotherapy

Chemotherapy is one of the primary treatment modes for mesothelioma. Chemotherapy, a strong medicine used to kill cancer cells, is delivered via an infusion in cycles over a period of several months.

Unfortunately, chemotherapy drugs don’t distinguish between cancerous and normal cells, and they kill off healthy cells as well. As a result, patients who undergo mesothelioma chemotherapy commonly experience side effects, including anemia, nausea or other digestive disruption, and hair loss.

The most common chemotherapy treatment for mesothelioma is the combination of Alimta (pemetrexed), which was approved by the U.S. Food & Drug Administration in 2004, and cisplatin, a long- standing staple of many chemo treatments.

Radiation

Radiation therapy uses high-energy ionizing radiation to kill cancer cells. Ionizing radiation changes the structure of DNA in cells, thus inhibiting growth and division.

Radiation is used in most cases of mesothelioma. However, pinpointing the malignant cells is difficult, resulting in damage to healthy cells as well. The side effects of radiation are similar to those for chemotherapy and include hair loss, digestive problems, and anemia.

Recent breakthroughs in the use of proton therapy, which uses a beam of protons to irradiate the tumors, as opposed to X-ray beams used in conventional radiation therapy, are allowing physicians to target deep-seated tumors with greater precision, limiting damage to the surrounding tissue.

Mesothelioma Alternative Treatments

Immunotherapy

“Immunotherapy is a new class of cancer treatment that works to harness the innate powers of the immune system to fight cancer,” according to the Cancer Research Institute. Recharging the body’s own defense mechanism, the immune system, immunotherapy may hold greater potential than current treatment approaches:

Keytruda is one immunotherapy treatment that has led the news recently. Not only have several long-term mesothelioma survivors seen great benefits from this drug, but 91-year-old, former US president Jimmy Carter announced the drug helped him beat melanoma that had metastasized to his liver and brain.

The drug, developed by Merck, suppresses the PD-L1 biomarker found in cancer cells. PD-L1, or programmed death-ligand 1, is a protein that has been shown to play a role in suppressing the immune system during cancer and other diseases.

Opdivo, developed by Bristol-Myers Squibb, is another FDA-approved lung cancer, immunotherapy drug that works by blocking the PD-L1 protein and activating the immune system. Except for the dosing differences, Opdivo and Keytruda are comparable, according to reports.

SMART Treatment Promising

The ‘Surgery for Mesothelioma After Radiation Therapy’ study, conducted by researchers at Princess Margaret Cancer Center in Toronto, more than doubled three-year survival rates of mesothelioma patients who underwent radiation therapy followed within a week of an extrapleural pneumonectomy surgery to remove the lung.

The survival rates improved to 72%, from 32%, and the patients experienced “shorter treatment, fewer complications and speedier recovery,” according to Dr. John Cho, radiation oncologist and partner in the study.

The SMART approach also reduced the risk of recurrence, according to the researchers, because the radiation halted the mesothelioma cancer cells ability to seed itself elsewhere in the chest or abdomen during surgery.

“These research results offer real hope to mesothelioma patients who have too often been told in the past that they may have only six months to live,” say the researchers.

Since the study was published in 2014, the physicians have used the SMART approach to successfully treat at least 20 more patients.

Mesothelioma Clinical Trials

According to the National Institutes of Health, clinical trials are at the heart of all medical advances. Clinical trials serve to uncover better ways to treat, prevent, diagnose and understand human disease. They provide mesothelioma researchers with critical information needed to allow them to move their findings from the lab to patients. For some mesothelioma patients, clinical trials offer an opportunity to try a treatment that is not otherwise available.

There are benefits and risks to participating in clinical trials. In the U.S., clinical trials are closely monitored and are run according to strict guidelines. The NIH explains that federally funded clinical research has safeguards in place to protect the participants. Deciding whether to enter into a clinical trial is a patient’s personal choice, and the benefits and risks should be carefully weighed.

Mesothelioma patients are encouraged to work closely with their doctors to determine the best treatment plan for their needs. The treatment plan you and your doctor develop will depend on several factors, including the type and stage of disease, and your overall health.

Mesothelioma is one of the most aggressive cancers, and, as a result, is one of the most challenging to treat. Surgery, chemotherapy and radiation are the primary treatment protocols; however, while these treatments can relieve symptoms, they do little to improve survival. When patients are diagnosed with the terminal cancer, they are often given just a year to live.

Recent breakthroughs in cancer research in general have meant an improvement in survival of mesothelioma patients.

Patients in clinical trials often have higher survival as they benefit from the current research to bring new, effective treatments to patients. Mesothelioma patients in clinical trials have access to treatments that may not otherwise be available to them.

What is a clinical trial, and is it right for me?

The National Cancer Institute describes clinical trials as “the final step in a long process” that starts with a lot of research in a laboratory and tests on animals. The clinical trial portion of the process involves testing the treatment on real human patients to determine whether or not it is effective and safe. The hope is always that the treatment will help the patients, but there is a risk that it could be harmful or have no effect.

Mesothelioma clinical trials may include a variety of treatment options, and not all patients who participate will be trying a brand-new treatment. As ClinicalTrials.gov explains, trials may include:

• Testing new drugs or medical devices.
• Trying new medical procedures.
• Experimenting with changes to patients’ behavior, such as diet.
• Comparing a new medical approach to a standard one.
• Comparing a new treatment to a placebo (which contains no active ingredients).
• Comparing two treatments that are already available.

Talk to your doctor and medical team about the potential risks and rewards of participating in a mesothelioma clinical trial. Also consider talking to other patients who have participated in these types of clinical trials and research to get their perspectives.

Who pays for clinical trials? Are there costs for patients who participate?

In most cases, patients do not pay to participate in the trials themselves. The costs of the research done in the clinical trial are often covered by the government, nonprofit agency, or company that is sponsoring the mesothelioma clinical trial, according to the National Cancer Institute.

However, patients may still be on the hook for routine medical costs that they would have incurred even if they were not participating in a clinical trial, such as regular doctor visits and exams. The National Cancer Institute warns that patients should check with their insurance plans before participating in a mesothelioma clinical trial because some plans won’t cover routine medical costs if a patient is part of a trial. Patients also need to take into account the potential expense of traveling and lodging during a mesothelioma clinical trial.

What are the stages of a mesothelioma clinical trial?

The Food and Drug Administration (FDA) oversees the approval process for medical treatments in the United States. Once a drug has been developed and tested on animals, the drug’s sponsor submits an application to the FDA to start the clinical trial process, which includes four phases:

• Phase 1: About 20 to 80 healthy people are usually chosen for phase 1 of a clinical trial, where the goal is to identify common side effects and how the drug is metabolized and excreted. This phase focuses on safety.
• Phase 2: Hundreds of people are chosen to participate in phase 2 of a clinical trial, which focuses on the treatment’s effectiveness. In this phase, participants with mesothelioma receive the treatment and, in many cases, the effectiveness will be measured against other patients who are receiving a placebo or different treatment.
• Phase 3: At this stage, the clinical trial is expanded to include even more participants. The goal is to study the safety and effectiveness among various populations, using different dosages and testing the drug in combination with other drugs.
• Phase 4: This phase actually occurs after the FDA has approved a drug for marketing. Doctors and patients continue to report side effects, and the sponsor (which is usually the manufacturer of the drug) is required to provide updates to the FDA as new information about the drug’s effects is discovered.

How can a patient qualify for a mesothelioma clinical trial?

If you are interested in participating in a mesothelioma clinical trial, start by talking to your doctor about your options. You will first need to know specific details about your mesothelioma diagnosis that you can compare to the eligibility criteria for any trials you are interested in. The National Cancer Institute offers a Cancer Detail Checklist that you and your medical team can fill out to get started.

When looking for treatment clinical trials for malignant mesothelioma, there is no one-stop shop that lists them all. Trials can be sponsored by the government, nonprofit agencies, pharmaceutical companies, and medical centers with researchers on staff. However, here are a few good places to start your search:

When you find a mesothelioma clinical trial that you are interested in, the National Cancer Institute suggests you print a copy of the clinical trial summary, which should explain the basic details of the trial and where it is taking place.

What questions should I ask my doctor?

You should always learn as much as you can about a mesothelioma clinical trial before deciding whether to participate in it. You have a right to ask your doctor and the research team about all aspects of the study, the medications or procedures involved, and any related expenses.

ClinicalTrials.gov suggests that patients ask the following questions when considering participating in a clinical trial:

• What exactly is being studied, and what will I have to do?
• What tests and procedures are involved?
• How often will I have to visit the hospital or clinic? Will hospitalization be required?
• Why do researchers think the intervention being tested might be effective? Why might it not be? Has it been tested before?
• How do the possible risks, side effects, and benefits of this trial compare with those of my current treatment?
• What are the possible interventions that I might receive during the trial? And how will that be determined (for example, by chance)?
• Who will oversee my medical care while I am participating in the trial?
• What will happen if I am injured during the study?
• How long will the study last?
• Who will pay for my participation? Will I be reimbursed for other expenses such as travel?
• If I benefit from the intervention, can I continue receiving it after the trial ends?
• What type of long-term follow-up care is part of this trial?
• Will results of the study be provided to me?

Finding Hope Through Mesothelioma Research

Whether you’ve just been diagnosed with mesothelioma or are well into your treatment journey, know that doctors and researchers are constantly searching for more and better alternative treatment options through clinical trials. And remember, most of the effective treatments we take for granted today were first tested in clinical trials.

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Below is a list of current clinical trials for mesothelioma . You can find additional trials by searching on mesothelioma at National Cancer Institute’s clinical trials website, which you can access by clicking here:https://www.clinicaltrials.gov/ct/screen/SimpleSearch

• Do Your Genes Put You at a Higher Risk of Developing Mesothelioma
  Condition: Mesothelioma
  Intervention: Not Provided
  Sponsors: Wake Forest School of Medicine
  Completed: December 2014 (final data collection date for primary outcome measure)
• Intrapleural Administration of HSV1716 to Treat Patients With Malignant Pleural Mesothelioma.
  Condition: Malignant Pleural Mesothelioma
  Intervention: Biological: HSV1716 Intra-pleural delivery
  Sponsors: Virttu Biologics Limited
  Completed: June 2015 (final data collection date for primary outcome measure)
• SS1P and Pentostatin Plus Cyclophosphamide for Mesothelioma
  Condition: Mesothelioma
  Interventions: Drug: Pentostatin; Drug: Cyclophosphamide; Biological: SS1(dsFv)PE38
  Sponsors: National Cancer Institute (NCI)
  Completed: April 2016 (final data collection date for primary outcome measure)
• Dendritic Cells Loaded With Allogeneous Cell Lysate in Mesothelioma Patients
  Condition: Mesothelioma
  Intervention: Biological: MesoCancerVac
  Sponsors: Erasmus Medical Center
  Completed: December 2015 (final data collection date for primary outcome measure)
• Alisertib in Malignant Mesothelioma
  Conditions: Lung Cancer; Mesothelioma
  Intervention: Drug: Alisertib
  Sponsors: M.D. Anderson Cancer Center
  Completed: May 2021 (final data collection date for primary outcome measure)
• Response Evaluation in Malignant Pleural Mesothelioma
  Condition: Malignant Pleural Mesothelioma
  Intervention: Not Provided
  Sponsors: Istituto Clinico Humanitas (Italy)
  Completed: May 2015 (final data collection date for primary outcome measure)
• Intrapleural Measles Virus Therapy in Patients With Malignant Pleural Mesothelioma
  Conditions: Recurrent Malignant Mesothelioma; Stage IA Malignant Mesothelioma; Stage IB Malignant Mesothelioma; Stage II Malignant Mesothelioma; Stage III Malignant Mesothelioma; Stage IV Malignant Mesothelioma
  Interventions: Biological: oncolytic measles virus encoding thyroidal sodium iodide symporter; Other: laboratory biomarker analysis; Procedure: single photon emission computed tomography; Procedure: computed tomography
  Sponsors: Mayo Clinic
  Completed: December 2016 (final data collection date for primary outcome measure)
• Pemetrexed Disodium or Observation in Treating Patients With Malignant Pleural Mesothelioma Without Progressive Disease After First-Line Chemotherapy
  Condition: Malignant Mesothelioma
  Interventions: Drug: pemetrexed disodium; Other: clinical observation
  Sponsors: Cancer and Leukemia Group B
  Completed: December 2015 (final data collection date for primary outcome measure)
• PIT: Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma
  Condition: Mesothelioma
  Intervention: Radiation: Prophylactic Irradiation of Tracts (PIT)
  Sponsors: Colin Lunt
  Completed: May 2017 (final data collection date for primary outcome measure)
• ATREUS – Phase II Study on the Activity of Trabectedin in Patients With Malignant Pleural Mesothelioma (MPM)
  Condition: Malignant Pleural Mesothelioma
  Intervention: Drug: Trabectedin
  Sponsors: Mario Negri Institute for Pharmacological Research
  Completed: October 2015 (final data collection date for primary outcome measure)
• Safety and Efficacy of Listeria in Combination With Chemotherapy as Front-line Treatment for Malignant Pleural Mesothelioma
  Condition: Malignant Pleural Mesothelioma
  Interventions: Biological: Vaccine plus chemotherapy; Biological: Vaccine with cyclophosphamide plus chemotherapy
  Sponsors: Aduro BioTech, Inc.
  Completed: December 2015 (final data collection date for primary outcome measure)
• Window of Opportunity Study of VS-6063 (Defactinib) in Participants With Surgical Resectable Malignant Pleural Mesothelioma.
  Condition: Malignant Pleural Mesothelioma
  Intervention: Drug: VS-6063
  Sponsors: Verastem, Inc.
  Completed: November 2015 (final data collection date for primary outcome measure)
• Pembrolizumab in Treating Patients With Malignant Mesothelioma
  Conditions: Biphasic Mesothelioma; Epithelioid Mesothelioma; Peritoneal Malignant Mesothelioma; Pleural Biphasic Mesothelioma; Pleural Epithelioid Mesothelioma; Pleural Malignant Mesothelioma; Pleural Sarcomatoid Mesothelioma; Recurrent Peritoneal Malignant Mesothelioma; Recurrent Pleural Malignant Mesothelioma; Sarcomatoid Mesothelioma
  Interventions: Biological: Pembrolizumab; Other: Laboratory Biomarker Analysis; Other: Pharmacogenomic Study
  Sponsors: University of Chicago
  Completed: March 2018 (final data collection date for primary outcome measure)

Some clinical trials making headlines include:

CRS-207 Shows “Impressive” Results

Aduro-Biotech announced early findings of its multi-center, Phase 1b mesothelioma clinical trial designed to assess the efficacy of CRS-207 when used in combination with chemotherapy drugs pemetrexed and cisplatin for patients with malignant pleural mesothelioma. Initial results of 38 patients included disease control in 94% of the patients, 59% with partial response and 35% experiencing stable disease following treatment with CRS-207 and chemotherapy.

“The data in this trial continue to be impressive in the front-line treatment of mesothelioma,” reports the researchers.

CRS-207, an immunotherapy drug that has been engineered to express the tumor-associated antigen mesothelin, which is over-expressed in mesothelioma, has gained orphan drug designation from the U.S. Food and Drug Administration.

Triplet Therapy for Mesothelioma

The French Cooperative Thoracic Intergroup report results from its randomized Phase 3 trial, where patients with mesothelioma were treated with the combination chemotherapy regimen of pemetrexed/cisplatin with or without bevacizumab (Avastin), saying the trial resulted in “a significantly longer survival” for patients receiving bevacizumab with pemetrexed/cisplatin.

The results are so impressive that the study authors are saying, “The treatment of pemetrexed, cisplatin, and bevacizumab is a new treatment paradigm for patients with malignant pleural mesothelioma.”

If you find a clinical trial that you believe will benefit you, talk to your doctor. For a complete list of current mesothelioma clinical trials see ClinicalTrials.gov.

Q&A: Latest Treatments for Mesothelioma

Researchers are studying whether chemotherapy before surgery and radiation can deter tumor recurrence in patients with mesothelioma, a rare cancer of the lining of the chest caused by asbestos exposure.

The study builds on the success of a previous clinical trial at M.D. Anderson that included surgery called extra pleural pneumonectomy (EPP), which involves removal of the affected lung and lining of the chest, followed by a highly specialized form of radiation therapy known as Intensity Modulated Radiotherapy (IMRT).

The new multi-center study, which will recruit 77 patients nationwide, will involve EPP, post-operative IMRT and the chemotherapy drugs pemetrexed (Alimta®) and cisplatin, says Katherine Pisters, M.D., principal investigator on the study at M.D. Anderson and associate professor in the Department of Thoracic/Head and Neck Medical Oncology.

The other trial locations are:

Many of the sites already have begun studying the use of chemotherapy prior to surgery and radiation. The chemotherapy combination of pemetrexed and cisplatin was approved by the Food and Drug Administration (FDA) for treatment of mesothelioma after the drugs were shown to prolong survival.

Answering questions about both studies are Pisters, Craig Stevens, M.D., Ph.D., principal investigator on the previous M. D. Anderson trial and associate professor in the Division of Radiation Oncology; and David Rice, M.D., surgical principal investigator on the new study and assistant professor in the Department of Thoracic and Cardiovascular Surgery.

What is unique about this study?

Pisters: This is the first mesothelioma trial to explore the use of chemotherapy before surgery and radiation.

How does the new trial build on the previous study?

Stevens: Our previous trial involving extrapleural pneumonectomy and IMRT was more than 90% effective in preventing a local recurrence (return of the cancer to its original site). However, 50% of those patients experienced recurrence in a different location, usually the other lung, abdomen or another part of the body. M.D. Anderson will be the only center employing IMRT rather than conventional radiation therapy.

Pisters: We are now adding chemotherapy before surgery and radiation to decrease the possibility of distant cancer metastasis (spread to an area away from the original site). We are using pemetrexed and cisplatin because they already have been shown to be effective in metastatic disease.

Read the Entire Articles and Mesothelioma Questions & Answers section at Cancer Wise.org, click here.