Malignant Pleural Mesothelioma Treatment
The treatment for mesothelioma pleural depends on the stage and whether the tumour is resectable (can be removed by surgery). Doctors also consider a person's health and whether the cancer has recurred after previous treatments.
Immunotherapy drugs like pembrolizumab (Keytruda) and Nivolumab (Opdivo) aid immune cells to identify and destroy mesothelioma cell. Other immunotherapies are available through clinical trials.
Treatment Options
New treatment options are constantly improving the prognosis of people with mesothelioma. The treatments are able to prolong the life of patients and ease symptoms such as pain.
Mesothelioma specialists can design an extensive treatment plan for each patient, which will comprise a variety of treatments. A lot of patients with mesothelioma take part in clinical studies that test the latest therapies. These are typically offered at cancer centers which specialize in treating mesothelioma.
Surgery is the most effective option for treating mesothelioma because it eliminates tumors directly. To treat pleural cancer doctors can employ a variety of surgical methods. One of the procedures, called extrapleural pneumonectomy (EPP) involves the removal of the lining around the lung and a small portion of the diaphragm as well as the pericardium. If necessary, doctors may also remove organs.
Chemotherapy is used to kill cancerous cells and prevent the growth or spread of cancerous cells. This kind of treatment can be administered prior to or after surgery, as well as during or following it. In certain instances doctors mix chemotherapy with other procedures or radiation.
Radiation therapy can reduce pain by shrinking tumors pressing on nerves, bones or major blood vessels. It can be given before or after EPP surgery. Doctors can also administer radiation after a pleurectomy/decortication (P/D) surgery as an alternative to more invasive procedures.
Certain patients respond to immunotherapy with interleukin-2. The antibody IL-2 fights malignant pleural mesothelioma cells. It can be injected into the chest cavity or given through an intravenous line (IV).
Palliative care is a treatment that is that is designed to help patients feel better and ease side effects of mesothelioma and its treatment. It can include treatments to ease pain and other issues such nausea and vomiting. It can also involve alternative treatments like yoga, acupuncture and meditation.
Chemotherapy
Chemotherapy, a systemic treatment, uses cancer-killing agents to stop the growth of tumors. Patients usually receive chemotherapy drugs in combination like cisplatin and pemetrexed. These drugs work together to improve efficiency and results. These medications may be given prior to, during or following surgery (neoadjuvant) or in addition to surgery (adjuvant).
Doctors will recommend different treatment options depending on the stage of mesothelioma, and other aspects. It is important to discuss your options with your doctor. This is referred to as shared decision making. It allows you and your physician to select an appropriate treatment plan that is compatible with the goals of your treatment.
Your doctor will conduct an examination to determine the stage of your mesothelioma. A doctor will insert a ultra-thin tube into the chest or abdomen, and then use special tools in order to collect tissue samples. The sample is then tested to determine if it contains cancerous cells.
Asbestos fibers can cause irritation to cells in the lungs and cause pleural mesothelioma. The mesothelial cells transform and develops into an abnormal tumor. A biopsy is the only way to determine whether you have mesothelioma.
If your pleural mesothelioma is in its initial stages, surgery may help improve your prognosis. Two surgical treatments are available: extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). In EPP, doctors remove the affected lung and, in some instances, all or part of the diaphragm. P/D surgery involves the elimination of the pleura, and, in many cases, parts of pericardium.
This surgical procedure may be utilized for the treatment of peritoneal cancer. The use of immunotherapy and/or radiation may be beneficial for patients with unresectable mesothelioma pleural. Combining nivolumab and ipilimumab also referred to as Opdivo and Yervoy together with conventional mesothelioma treatments can improve the chance of survival.
A new emerging mesothelioma treatment is epigenetic therapy, which seeks to reverse asbestos damage and restore normal DNA expression. The drug tazemetostat, which targets BAP1 enzymes that are involved in epigenetic control, is in the second phase of clinical trials. This is a promising treatment for patients suffering from persistent pleural mesothelioma.
Radiation
Radiation therapy can ease symptoms and extend the life of patients by shrinking tumors, which reduce pressure on the lungs. Mesothelioma specialists employ a variety of radiation therapy. One alternative is three-dimensional conformal radiation therapy (3DCRT), which aims multiple beams of radiation toward the cancerous tissue at different angles. Doctors can also employ intensity-modulated radiation therapy (IMRT) to focus on specific areas of the tumor and limit the radiation exposure to healthy tissue around it.
Immunotherapy can enhance the efficacy of traditional treatments. This type of treatment increases the body's natural defenses against mesothelioma and may reduce the likelihood of recurrence. It is being tested in clinical trials or as an addition to conventional mesothelioma treatment. Two immunotherapy drugs, Opdivo (nivolumab) and Yervoy (ipilimumab), were approved by the FDA in 2020 to treat pleural mesothelioma. Other immunotherapy drugs are currently being developed and are showing promise in clinical trials.
Surgery can alleviate the symptoms and also eliminate mesothelioma. For mesothelioma of the pleural region, surgeons usually perform a procedure known as pleurectomy and decortication or P/D. The lungs are not affected by P/D, which eliminates only the pleura where the majority cancer cells are located. It is most effective in early stage mesothelioma and is sometimes performed in conjunction with chemotherapy prior to or after surgery.
Doctors can drain fluid out of the chest through a less invasive procedure to alleviate breathing problems triggered by excess fluid. They can also inject drugs in the chest to avoid the reaccumulation of fluid (pleurodesis).
Palliative treatment for mesothelioma is not a cure, but it can reduce symptoms and improve the quality of living. Patients suffering from mesothelioma should discuss their treatment goals and expectations with a specialist.
Mesothelioma specialist physicians can provide an extensive mesothelioma treatment program. They will review the latest research and your health background to develop an effective treatment plan to allow you to live longer and manage your symptoms. Your mesothelioma specialist will work with other health professionals, such as nurses, social workers, physician assistants and counselors to ensure you receive the highest quality of care. A mesothelioma care team can also suggest clinical trials to evaluate new treatments.
Surgery
If mesothelioma is detected at a lower stage, surgeons can remove the tumor and alleviate symptoms. However, most mesothelioma cases are diagnosed at more advanced stages, meaning that the cancer has spread and cannot be removed surgically. The goal is to control symptoms and extend survival.
Your doctor might suggest a range of treatments to treat pleural mesothelioma. Treatment options include chemotherapy, surgery and radiation. Immunotherapy is a newer treatment that boosts the immune system of a patient to fight mesothelioma. These treatments can prolong life and improve the quality of life, however they cannot end the disease.
To diagnose pleural mesothelioma, your doctor will collect an in-tissue sample to check for cancerous cells. The doctor will make the biopsy method or another procedure, like bronchoscopy or video-assisted thoracic surgery (VATS) to create the sample. A doctor can also perform lung function tests to measure breathing ability or a chest x-ray to see how the lungs are working.
After your doctor has confirmed that you have mesothelioma pleural, they will assign a cancer stage based on its location and other aspects. These stages are indicated by Roman numerals with one being the least advanced, and four being the most advanced.
The stage of a pleural cancer determines if it can be surgically treated. Stage I or II pleural cancer is the most curable because it isn't spreading beyond the pleura.
Doctors can perform surgery if your mesothelioma is at an advanced stage. They can perform either an extrapleural lung pneumonectomy (EPP) which involves the entire lung is removed, or a pleurectomy and decortication (P/D), which removes only the visible tumor, as well as the diseased pleura.
You'll likely be admitted to the hospital following surgery. Nurses will administer pain medication to ensure your comfort if you feel groggy or confused after the anesthesia has worn off. If you're staying overnight and you are in a hospital bed, you will be transferred to a normal hospital bed. In other cases, you will be supervised at the outpatient clinic until the time you return home.