Mesothelioma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

The treatment for mesothelioma depend on various factors, which include:

• Location of the mesothelioma
• Stage
• Resectability of the tumor
• Type of symptoms
• Overall health and performance status
• Performance status
• Age

The various treatment options for mesothelioma include:

Treatment of Mesothelioma

Supportive Care

Radiotherapy

Chemotherapy

Surgery

Supportive Care

Concern	Supportive Care
Loss of appetite	Small amounts of high-calorie foods or fluids, having smaller, more frequent meals, and nutritional supplements can be helpful. Anti-emetic drugs can be used to control nausea and vomiting. Cold foods may be better tolerated and using plastic cutlery can help if foods have a metallic taste. When appropriate, medicines may be prescribed to help increase appetite. Cachexia can occur in people whose mesothelioma is very advanced.
Shortness of breath	Pleural effusion is common with pleural mesothelioma, but can also occur with some peritoneal mesothelioma. Treatment options for pleural effusion may include: thoracentesis pleurodesis chest tube insertionto drain the fluid that has collected in the pleural space radiation therapy may be given, after thoracentesis, to try to prevent fluid from building up again Relaxation and breathing exercises may help with problems breathing. Oxygen therapy may be ordered to help relieve difficulty breathing.
Ascites	Peritoneal mesothelioma can cause ascites. Paracentesis may be done to relieve symptoms. Another option is to insert catheter to drain the fluid from the abdomen.
Pain	People with advanced mesothelioma may experience pain because the tumor grows into surrounding nerves and organs. The amount of pain often increases as the cancer advances. Pain may be managed by: External beam radiation therapy: Palliative radiation therapy may help relieve pain by shrinking tumors that press on nerves or other organs. Palliative surgery: Palliative surgery or procedures are not used to remove the tumor, but are done to relieve pain or other problems, such as pleural effusion or ascites. Palliative surgery or procedures may include: pleurectomy and decortication (P/D) thoracentesis pleurodesis paracentesis Pain-relieving medications: Pain medications are used, especially for advanced mesothelioma.
Fatigue	Poor appetite and trouble breathing can also make fatigue worse. It can be hard to cope when you are feeling very tired and don’t have a lot of energy, especially for a while after treatment or if the cancer is advanced.
Bowel obstruction	Bowel obstruction can occur in people with peritoneal mesothelioma. A bowel obstruction can cause abdominal pain, nausea, vomiting, and an inability to pass feces. Resting the bowel by not having anything to eat or drink, or feeding through a nasogastric tube placement may help, but surgery to remove the obstruction may be necessary.
Coping with advanced cancer	Mesothelioma is often diagnosed at an advanced stage. People with advanced mesothelioma are offered palliative care. This is a special type of care that focuses on making the person as comfortable as possible, relieving symptoms, providing support and improving or maintaining the person’s quality of life.
Financial concerns	People with mesothelioma may have financial concerns as a result of their illness. There are special services or benefits to help workers (and their families) who have developed mesothelioma from occupational exposure to asbestos. Conditions about exposure and legal processing of claims for asbestos-related cancers can differ by province or territory.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.

Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major 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. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

References

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