How Is Mesothelioma Treatment Changing?
How Is Mesothelioma Treatment Changing?

How Is Mesothelioma Treatment Changing?

Author:Emily Rodgers

For decades the standard approach to treating mesothelioma hasn’t changed much. A combination of surgery, chemotherapy and radiation, is still the agreed upon standard of care.

Scientists have experimented with different chemotherapy drugs and combos since the beginning, but it wasn’t until 2003 that the Food and Drug Administration approved the first drug for mesothelioma. A signal that treatments were getting better.

It’s been over 10 years since the FDA-approval of the chemotherapy drug Alimta. There hasn’t been much difference in the realm of chemotherapy since then.

Mesothelioma patients and the future of better treatments needed a paradigm shift.

Targeted and Maintenance Therapy

In mesothelioma, it’s generally accepted that surgery is the best means of improving a patient’s life expectancy. The theory among many doctors used to be that removing as much of the visible tumors and nearby tissue was the best way to kill mesothelioma. And using the maximum amount of radiation and chemotherapy would also do the trick. Most doctors now are leaning toward treatments that target mesothelioma and maintain the patient’s health over time.

Targeted therapy is when doctors aim treatments directly at individual cancer cells. This is accomplished with new drugs and relying more on minimally invasive surgeries like the lung-sparing pleurectomy with decortication. The idea is to do the least harm to the patient while causing the most damage to mesothelioma cells.

Maintenance treatments keep patients in long-term remission. If a patient has surgery that removed all signs of cancer, they often need a drug to keep the cancer from returning.

Novel approaches to mesothelioma are more able to kill cancerous cells while leaving healthy cells unharmed. This mitigates side effects and gives patients a better overall quality of life.

Emerging Treatments for Mesothelioma

In 2017, doctors have published promising research into novel treatments. More and more doctors are reporting survival times that were previously unheard of.

Immunotherapy

No other emerging treatment is taking the concept of targeted therapy further than immunotherapy. This type of treatment uses drugs that makes the immune system fight mesothelioma, something immune cells don’t normally do. Immunotherapy is also an excellent maintenance therapy drug because it keeps patients in remission.

Dr. Robert Cameron prescribes these drugs after surgery. This helps his patients live years past their initial prognosis. New studies also suggest that immunotherapy can be effective as a patient’s initial treatment when combined with chemotherapy. Interferons and Interleukin are two promising immunotherapy substances that modify the body’s biological response to mesothelioma cells.

SMART

It means Surgery for Mesothelioma After Radiation Therapy. Research from last year reported patients living an average of 4 years after this treatment. And these were late-stage mesothelioma patients. SMART involves super high doses of radiation to the patient’s affected lung. Before the dose can start harming the patient, surgeons remove the lung and affected tissue.

The theory about why SMART is so effective is that the high levels of radiation kill microscopic cancer cells around the main tumor masses. This increases the likelihood of the surgeon removing all cancer cells during surgery. An analysis published this year about SMART suggests that although there is a need for more research, it seems possible that this treatment will be here to stay.

Angiogenesis Inhibitors

The root of tumor development in any cancer is a process called angiogenesis. This term is what we call the formation and growth of blood vessels. Mesothelioma tumors need a constant blood supply to grow and spread, so blocking this supply is the impetus behind a process called antiangiogenesis. The drugs that accomplish antiangiogenesis are called angiogenesis inhibitors. It’s a targeted therapy that goes directly to the source of tumor formation.

This is one of the newer approaches to mesothelioma, but some patients are already benefitting. In the past, doctors have found mixed results for this type of treatment. But recent observations by mesothelioma specialists note the benefit of combining angiogenesis inhibitors with other drugs for increased survival. Multiple antiangiogenesis drugs are being tested now. Some doctors anticipate upcoming research testing a combination of angiogenesis inhibitors with immunotherapy drugs.

Photodynamic Therapy

The future of mesothelioma will include surgery as a foundation for long-term survival. Doctors across the field have generally accepted that surgery combined with other treatments creates the best situation for long-term survival. The difficulty is often overcoming the difficulties with advanced mesothelioma. In its advanced stages, mesothelioma isn’t curbed by surgery. Surgeons simply can’t take out all the small mesothelioma cells in the chest. In these cases, surgery is a hassle for patients.

A new study on photodynamic therapy, however, challenges the assumption that late-stage patients have nothing to benefit from surgery. Photodynamic therapy (PDT) targets and kills mesothelioma cells marked with a light-activated drug. Mesothelioma cells absorb the drug and a surgeon applies light during surgery. Photodynamic therapy helps clean up the cells that surgery left behind. A study from March of this year tested PDT in patients with stage 3 and 4 mesothelioma. The median survival time was more than triple the average survival time for stage 4 mesothelioma. And patients whose disease hadn’t spread to the lymph nodes had a median survival of 7.2 years.

Late-stage Patients to Reap the Benefits

Patients that were once considered a lost cause are now living longer than ever before. This is the main benefit coming from current advances in mesothelioma treatment. And patients can take advantage of these treatments now.

The direction of mesothelioma treatment and the effort of doctors to reach a cure is far away, but it’s what has made current treatments possible.

A review of mesothelioma treatment this August reported that the median survival for mesothelioma patients is only 8 months, but it included another important factor into this statistic—nearly ⅓ of patients didn’t receive treatment.

When patients who refuse treatment are included in the statistics, it skews the hope of patients searching for possibilities. The recent research on emerging treatments shows that there is justification to be hopeful.

Novel Treatments in the VA

Only a major cancer center with a team of mesothelioma specialists will offer the emerging treatments mentioned above. Places like the Mayo Clinic are major research centers that offer innovative mesothelioma therapies. There is also access to some novel treatments in the VA Healthcare System.

Both VA hospitals housing mesothelioma specialists open the door to potential new treatments. The Los Angeles VA is home to a specialist working with immunotherapy, and the Boston VA is near the epicenter of some world-class treatment centers. And regardless where a veteran lives, he could use his VA benefits to take advantage of these emerging treatments.