Most mesothelioma patients receive multiple forms of treatment. This practice is referred to as multimodal therapy. The benefits of multimodal therapy include individually tailored treatment plans and the potential for a longer life span.
Multimodal Treatment of Mesothelioma
Multimodal treatment is important for every mesothelioma patient. A well-cited review in the European Respiratory Journal states that, “it is clear that multimodal therapy is necessary to improve long-term results.” Mesothelioma specialists worldwide agree that patients need multiple treatment modalities to reach long-term survival.
“Treatment modality” means “mode.” It is a technical term used often by doctors to discuss different possible modes of mesothelioma treatment.
Treatment modalities for mesothelioma include:
- Surgery. When this treatment is combined with one or more other modes, patients have the longest survival times. The type of surgery a doctor chooses depends on your mesothelioma type. It may also vary depending on other treatments you receive.
- Chemotherapy. Always the standard for systemic cancer treatment, chemotherapy is still an important part of Mesothelioma Treatment. In multimodal treatment, chemo may be given as part of a surgical procedure, radiation, or both.
- Radiation. Often used before, during, or after surgery. Doctors may also prescribe radiation as part of a multimodal treatment plan for patients who aren’t eligible for surgery.
- Emerging therapies. As researchers reach the limits of traditional treatment modes, they have looked for novel solutions. Emerging therapies could unlock the cure for mesothelioma. Combining emerging and traditional therapies increases this potential.
If you have an upcoming appointment with your surgeon or oncologist, request our free guide to the 14 questions you should ask your doctor regarding your mesothelioma diagnosis and possible treatment options.
The Key Component of Multimodal Therapy
Mesothelioma specialists widely support surgery as the best treatment for long-term survival. After surgery, it is easier for doctors to maintain and treat the remaining cancer.
Surgeries used in multimodal treatment include:
- Extrapleural pneumonectomy (EPP): Lung-removing surgery for pleural mesothelioma patients
- Pleurectomy with decortication (P/D): Lung-sparing surgery with similar survival rates as EPP
- Cytoreductive surgery (HIPEC): Surgical approach used by peritoneal mesothelioma surgeons
Several studies have shown that without a surgical multimodal approach, most patients have a survival time of about 12 months. The multimodal approach can double or triple this survival time.
The type of pleural surgery you receive depends on how your tumors have developed. Most surgeons are currently exploring the lung-sparing approach.
This is primarily because of a 2008 study that showed little difference in survival benefits between P/D and EPP. The authors stated that it “should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned.”
Multimodal surgical treatments are available through the U.S. Department of Veterans Affairs (VA).
Veterans with mesothelioma are eligible for treatment at one of the two VA hospitals that specialize in mesothelioma treatment: the Los Angeles and Boston VA Hospitals. The mesothelioma specialists at these centers are the best in the country. Those with VA health care can use their benefits to receive treatment.
Chemotherapy is often the first treatment a mesothelioma patient gets. Most patients receive a combination of drugs known as Alimta and cisplatin.
This drug combination extends survival times by about 3 months. This helps create more time to develop a strong multimodal treatment plan. When combined with surgery, chemotherapy is significantly more effective.
Neoadjuvant and Adjuvant Chemotherapy
Surgical candidates often receive chemotherapy before or after surgery, with the goal of both being to make surgery more effective:
- The neoadjuvant method prescribes chemo before surgery
- The adjuvant method prescribes chemo after surgery
It’s unclear whether neoadjuvant or adjuvant is more effective. Patients need a specialist to determine the most effective chemotherapy type.
One study found that patients with neoadjuvant chemotherapy and EPP had a median survival of 23 months. This is nearly double the median survival of all mesothelioma patients.
The study also reported that, at the time of publishing, 2 patients still showed no signs of mesothelioma more than 38 months after treatment.
If you are a veteran in need of mesothelioma treatment, you may be entitled to receive certain benefits through the VA. Request our free Veterans Packet to explore your options.
Many mesothelioma specialists use chemotherapy during surgery. This allows them to use larger doses without the risk of severe side effects because the drugs are injected into the bloodstream. Intraoperative chemotherapy is possible in pleural and peritoneal mesothelioma.
From 2001 to 2009, the late Dr. David Sugarbaker treated 72 patients using intraoperative chemotherapy and found they:
- Had a median survival of 35 months
- Lived about 1 year longer than those who had surgery without intraoperative chemotherapy
Peritoneal mesothelioma patients receiving intraoperative chemotherapy have even better survival times. A multicenter analysis of HIPEC (heated intraperitoneal chemotherapy) reported a median survival of 53 months, with more than 50% of the patients living longer than 4 years after treatment.
Choosing a cancer center that specializes in mesothelioma is the best way to improve your prognosis. A study by a mesothelioma cancer center reported median survival times greater than 8 years in patients who had undergone the HIPEC procedure.
Radiation is another important mode of treatment for mesothelioma. Radiation is used in both neoadjuvant and adjuvant methods.
Radiation is most commonly used as an adjuvant therapy. The purpose of following surgery with radiation is to prevent tumors from regrowing. A study of adjuvant radiation reported a median survival of 33 months. More than half of the patients with surgery plus radiation lived even longer.
Though adjuvant radiation is common, the way specialists look at radiation is changing because of a 2014 study. Mesothelioma specialists reported on a neoadjuvant radiation method that led to an 84% 3-year survival rate, and all patients in that study were in stage 3 or 4 of their disease.
For comparison, the average 2-year survival rate is less than 30% for late-stage mesothelioma patients.
The late-stage patients in the neoadjuvant radiation study were part of a trial called SMART. The acronym means “Surgery for Mesothelioma After Radiation Therapy.”
Patients receive high doses of radiation shortly before their diseased lung is removed. Doctors are still testing this method, but the outlook for the future is positive.
Radiation plus chemotherapy is also a popular multimodal treatment plan for advanced mesothelioma. These patients are often ineligible for surgery. The addition of radiation to standard chemotherapy can extend survival.
The research on multimodal therapy is overwhelming in favor of combining different modes of treatment. Naturally, doctors have been testing the combination of 3 modes, rather than just 2.
Back in 1999, doctors were already reporting patients who doubled their survival times with trimodal therapy. The method involved neoadjuvant chemotherapy and surgery followed by radiation therapy.
The doctors also reported that carefully selected patients had even longer survival times. Those patients had median survival times of more than 4 years.
The research on trimodal therapy shows the survival benefit to surgical candidates. But it also highlights the importance of seeing a specialist.
Mesothelioma specialists are familiar with this research and know which modes of treatment are most likely to help you.
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The progress of traditional modes of cancer therapy has progressed slowly in Mesothelioma Treatment. Researchers have struggled to make chemotherapy and radiation more effective, so many doctors are turning to newer forms of cancer treatment.
Some emerging treatments used in multimodal therapy include:
- Immunotherapy. This treatment uses the immune system to fight mesothelioma cells in the body. It benefits patients who aren’t responding to chemotherapy and those who aren’t eligible for surgery. It also causes few side effects. Doctors have used immunotherapy as a maintenance treatment after surgery with notable success.
- Gene therapy. Gene therapy, like immunotherapy, uses the body’s own mechanisms to fight mesothelioma. Gene therapy targets mesothelioma cells, leaving healthy cells unharmed. This treatment method is in the clinical stages.
- Photodynamic therapy (PDT). This intraoperative treatment has led to survival times of about 3 years in patients with advanced mesothelioma. It involves a special light-activated drug to kill mesothelioma cells, and it’s applied during P/D surgery. It’s unclear for now whether the PDT or P/D was the main reason for success in that study.
Emerging therapies will, in all likelihood, make a major impact on the course of multimodal therapy for mesothelioma.
Getting Multimodal Therapy
Nearly every mesothelioma survivor received multiple modes of treatment. Whether it was intraoperative chemotherapy, neoadjuvant radiation or a combo of chemo and immunotherapy. One thing remains certain, long-term survival is unlikely without multiple forms of treatment.
Key facts about multimodal treatment:
- It leads to longer life expectancy
- Specialists may use different multimodal methods
The modes of treatment you receive largely depend on whether you’re eligible for surgery. Your treatment plan, in this case, may vary widely depending on the cancer center you go to.
For example, the Boston VA Hospital has mesothelioma specialists who use multimodality treatments while the Los Angeles VA Hospital may recommend surgery followed by immunotherapy. Patients ineligible for surgery commonly just receive chemotherapy and radiation.
Talk to our VA-accredited representative to discuss your options and benefits. Call (877) 450-8973 now.
Mesothelioma Multimodal Therapy FAQs
What are some treatment modalities for mesothelioma?
Treatment modalities for mesothelioma patients include combinations of chemotherapy, radiation therapy, and surgery.
Mesothelioma treatment options depend on several factors, including the stage of the cancer, the location of the tumor, and the patient's overall health.
Patients with mesothelioma should consult with a medical professional who specializes in this condition to develop an individualized treatment plan.
What are the most common surgeries for mesothelioma patients?
The most common types of surgery for multimodal treatments include:
- Extrapleural pneumonectomy (EPP): Removing the affected lung, the lining of the lungs, the diaphragm, and the lining of the heart
- Pleurectomy/decortication (P/D): Removing the pleura (lining of the lungs) affected by mesothelioma, the visible tumors, and any additional tissue that may be affected by the cancer
- Cytoreduction with heated intraperitoneal chemotherapy (HIPEC): Removing as much of the cancerous tissue as possible from the abdomen, followed by a heated chemotherapy wash to kill any remaining cancer cells
However, not all mesothelioma patients are candidates for surgery.
What are emerging therapies for mesothelioma?
Emerging therapies applied in multimodal therapy include:
- Gene therapy: Modifying a patient's genes to treat or prevent disease. In mesothelioma, gene therapy may involve delivering genes to cancer cells to stop their growth.
- Immunotherapy: Using drugs to help the immune system fight cancer. Several types of immunotherapy are being studied for mesothelioma, such as checkpoint inhibitors and CAR-T cell therapy.
- Photodynamic therapy: Using a special type of light and a photosensitizing agent to kill cancer cells.
These therapies are still being studied, and they may not be widely available or fully approved for use in mesothelioma treatment.
However, they offer hope for improving treatment options and outcomes for mesothelioma patients in the future.