Mesothelioma is a complex cancer diagnosis, and you’ll have a number of different treatment options presented to you by your doctors. They’ll most likely include surgery, radiation and chemotherapy, as well as new, cutting edge immunotherapy treatments. In some cases, you may qualify for experimental treatments or clinical trials, such as immunotherapy. Often, the treatment your doctor proposes will include a combination of two or more therapies, commonly called multimodal treatment. Your treatment team will consider many things in coming up with a treatment plan for you. Those considerations include:
- the cancer stage
- which type of mesothelioma you’re dealing with
- the primary site and type of cell affected
- whether the cancer is confined to the mesothelium or has spread to your chest wall, lymph nodes or other sites
- your age
- your overall health
Why Treatment Is Important
While there is no cure for mesothelioma yet, various treatments can improve your prognosis, improve your mobility and quality of life, and reduce pain and other symptoms arising from mesothelioma. Your doctor will explain the possible benefits – and drawbacks – of each therapy offered to you, and why a particular combination of therapies is the best option in your particular case.
Standard Mesothelioma Treatments
The standard treatments options for mesothelioma include surgery, chemotherapy, and radiation therapy. Here’s a quick summary of what each may involve, as well as why each may be proposed.
If the mesothelioma is in its early stages, your doctors may propose surgery to remove as much of the tumor(s) as possible. Depending on where the tumor is, the surgery may be limited to removing the mesothelium surrounding an organ or may include removing lymph nodes or part of your lungs or other organs.
Doctors often use chemotherapy together with surgery. They use drugs that attack fast-growing cells, such as cancer cells. Recent advances in cancer treatment have introduced cancer drugs that target cancer cells more effectively. You may also be prescribed medicines to counteract side effects, such as anti-nausea drugs.
Radiation can help shrink tumors, making them easier to remove through surgery, and sometimes eradicating them completely.
Multimodal Mesothelioma Treatment
Cancer specialists often recommend an approach that uses a combination of the three traditional mesothelioma treatments because studies have shown the combinations to work better than using each therapy individually. For example, radiation can shrink tumors, making them easier to remove surgically, and chemotherapy may “clean up” cancer cells that remain after surgery removes the primary tumor(s).
Emerging Mesothelioma Treatments
Researchers are working to expand the options available to treat mesothelioma. There are a number of treatment options that seem very promising. Some of these are undergoing clinical trials leading up to FDA approval, and at least one, Keytruda (pembrolizumab), has recently been approved for use in treating mesothelioma and other types of cancer under certain conditions.
Immunotherapy is one of the most promising lines of research in mesothelioma treatment. It works by activating or assisting your body’s immune system in recognizing and attacking cancer cells. Your immune system looks for a certain marker on cells to identify healthy cells that should be left alone. Some cancer cells “trick” the body into thinking that they belong because they carry those markers. Your immune cells “see” those markers and don’t attack the mesothelioma cells, letting them grow and spread. Immunotherapy drugs use various mechanisms to help your body find and attack those cells. Some of these treatments include:
- Antigen therapy sometimes called cancer vaccines, which introduces substances commonly found in cancer cells into the body, stimulating the immune system to produce antibodies against them
- Immune checkpoint inhibitors which interfere with signals sent by cells and allow the body to attack cancer cells
- Monoclonal antibodies, such as Keytruda, that use biomarkers to identify mesothelioma cells and attack them directly.
Some treatments using photodynamic therapy have been approved by the FDA for use with certain types of cancer, and are in clinical trials for use against mesothelioma. It generally involves introducing a drug that makes certain cells sensitive to light and following up with a laser to kill the sensitized cells.
If traditional mesothelioma treatments don’t work, or have been exhausted, you may qualify to participate in clinical trials for experimental mesothelioma therapy. These clinical trials may involve surgical therapies, chemotherapy, radiation, immunotherapy, or new ways of combining treatments that may offer specific benefits. Your treatment team may suggest your participation in a clinical trial based on your type of cancer, your medical history, your treatment history and other factors. Some of the most promising clinical trials include:
- extrapleural pneumonectomy
- intrapleural chemotherapy
- pleurectomy with decortication treatment
- cytoreduction with HIPEC
Your treatment team is likely to be aware of other clinical trials that may be appropriate for you and can help you decide whether to participate.