Although there is no definitive cure for mesothelioma, survivors are living longer thanks to advances in therapy and a multidisciplinary, individual patient-specific approach to treatment. Mesothelioma treatment plans typically consist of a combination of surgery, chemotherapy and radiation therapy and may include experimental treatments such as immunotherapy.
Multimodal Therapy Combination of surgery, chemotherapy and possibly radiation therapy
Immunotherapy Enhances immune system response to mesothelioma
Alternative Treatments Treats the cancer’s effects on the mind and body
Cost for Treatment Comparable to average lung cancer treatment costs of $60,709
There was a time when the only option for mesothelioma patients was palliative treatment, with the goal of relieving pain and other symptoms to improve quality of life.
After years of research and emerging technologies, many mesothelioma patients can now improve their prognosis through the latest groundbreaking treatments.
The treatments you receive will vary depending on the following factors:
Older patients or those in poor health may not be eligible for certain aggressive therapies.
When tumors are contained at or near the point of origin, a combination of surgery, chemotherapy and possibly radiation therapy likely will be offered. This combined approach to treatment is called multimodal therapy.
If the mesothelioma already has spread significantly, doctors typically recommend palliative treatments that can help alleviate pain, breathing problems and other cancer symptoms that lessen your quality of life. Chemotherapy and radiation will still likely also be offered in an effort to contain the spread and growth of the cancer and possibly prolong life. Widespread mesothelioma usually precludes aggressive surgery options, though palliative surgical procedures may be considered.
Dr. Jacques Fontaine sits down exclusively with Asbestos.com to talk about the treatment options available for mesothelioma patients.
Less invasive surgeries are available to drain fluid that builds up in the chest or abdomen, alleviating troublesome symptoms.
Many mesothelioma patients are eligible for clinical trials that test emerging treatments such as immunotherapy, gene therapy and the combination of different chemotherapy drugs.
It all starts with finding a qualified mesothelioma specialist. Mesothelioma represents only 0.3 percent of all cancers, so finding a cancer center with a staff that understands the intricacies of the rare asbestos-related cancer is essential.
The benefit [of a tumor board or multidisciplinary care] is that you can get a room full of feedback from multiple disciplines focused on your individual diagnosis.”
Surgery is used to treat and diagnose mesothelioma. Major aggressive surgeries aim to remove as much cancerous growth as possible, while palliative procedures control symptoms.
Aggressive Mesothelioma Surgeries
Although no mesothelioma surgery is considered curative, aggressive procedures are typically a patient’s best chance at long-term survival.
The following are the most common surgeries for treating malignant pleural mesothelioma.
Need Money for Surgery?
If you or a loved one has been diagnosed with mesothelioma, you may qualify for financial assistance.
The most common surgery for peritoneal mesothelioma patients is cytoreduction, which removes as much of the cancerous growths from the lining of the abdomen. Also known as debulking surgery, this procedure is often followed by hyperthermic intraperitoneal chemotherapy (HIPEC).
A pericardiectomy is the only tumor-removing surgery for pericardial mesothelioma, a rare type of the asbestos-related cancer that forms on the linings of the sac around the heart. This procedure aims to remove as much cancerous tissue as possible from the linings of the pericardial sac.
[My doctor] told me from the start, ‘We’ll fight this together. We’ll try and come up with something that works for you.’ I was so lucky to find her. Best thing that could have happened to me.”
– Gene Hartline Diagnosed with pleural mesothelioma in 2016
Palliative Mesothelioma Surgeries
Less aggressive and potentially traumatic surgeries are used if you are not healthy enough to withstand the strain of a major surgery, or if the cancer already has spread. The goal of these surgeries is to relieve symptoms and help you feel better. You may also have chemotherapy and radiation before or after these surgeries.
In some cases, palliative surgeries are performed months or years after aggressive procedures as a way to control recurring symptoms. Although there are several types of palliative mesothelioma surgeries, they all share the same goal: Remove excess fluid from the affected part of the body.
Pleurodesis
Treats pleural effusions by removing fluid from the space between the visceral lining and parietal lining of the lungs and closes the pleural space to prevent further buildup.
Chemotherapy can be used to treat most types of cancer, including malignant mesothelioma. The drugs can stop the growth of or kill cancer cells, and they are usually delivered intravenously or less commonly by mouth.
The standard and most effective first-line chemotherapy regimen for pleural mesothelioma patients is the combination of cisplatin and pemetrexed (Alimta). A related combination of pemetrexed and carboplatin often achieves the same results but with fewer side effects.
Chemotherapy for Peritoneal Mesothelioma
Peritoneal mesothelioma patients may be eligible for heated intraperitoneal chemotherapy.
Quick Fact
In a 2016 study, researchers at Wayne State University found mesothelioma patients who received one of the chemotherapy combinations survived three times longer than patients without chemotherapy.
In this procedure, drugs are delivered directly into the abdominal cavity after the debulking surgery has been done to kill any remaining visible and hopefully any microscopic cancer cells. According to 2013 study at Moffitt Cancer Center in Tampa, the median survival rate for peritoneal patients who underwent HIPEC and cytoreductive surgery was 41 months.
Those who returned for a second procedure survived an average of 80 months.
Intraperitoneal chemotherapy may also be administered without surgery and with the chemotherapy at normal room temperature.
Quick Fact
In a 2017 study led by Dr. Paul Sugarbaker, 75 percent of peritoneal mesothelioma patients survived at least five years after receiving three types of intraperitoneal chemotherapy: Normothermic intraperitoneal chemotherapy (NIPEC), HIPEC and early postoperative intraperitoneal chemotherapy (EPIC).
Side Effects of Chemotherapy
Since chemotherapy drugs affect cancer cells as well as healthy cells, you may feel worse after treatment. Some patients choose not to undergo chemotherapy because of fear of harsh side effects such as nausea, hair loss, fatigue and severe weight loss.
Today there are better medications available to reduce nausea and support blood cell levels to lessen fatigue. Not all chemotherapy drugs cause hair loss. Unfortunately, an untreated cancer may cause pain, nausea and weakness.
Therefore, patients may be counseled that negative side effects wear off over time, and many patients experience notable improvements. An experienced mesothelioma specialist can help you understand your options and decide the right chemotherapy regimen.
Radiation Therapy
Radiation therapy is noninvasive and uses high-energy rays to target cancer cells. It is typically paired with chemotherapy to help shrink tumors or manage tumor growth. It often doesn’t have the strong side effects of chemotherapy, and it can help reduce the physical pain of mesothelioma. Radiation can then be used palliatively to reduce symptoms when mesothelioma surgery is no longer an option.
However, because radiation can be toxic to various organs and damages DNA while killing cancer cells, it is used carefully. Pleural mesothelioma patients are more likely to receive radiation than peritoneal patients because of the location of the cancer.
I can’t tell you the amount of people I’ve talked to who are no longer here because they got treated by an oncologist and not a mesothelioma specialist. It happens so often.”
– Kasie Coleman Diagnosed with peritoneal mesothelioma in 2010
Emerging Mesothelioma Treatments
The future of mesothelioma treatment almost certainly involves therapies still being developed. There may be tremendous potential with immunotherapy, gene therapy and photodynamic therapy. All are being used in clinical trials and could become standard treatment at some point.
Immunotherapy
Helps your own immune system fight cancer. Some checkpoint inhibitors, such as pembrolizumab (Keytruda) and nivolumab (Opdivo), are already approved by the U.S. Food and Drug Administration (FDA) for the treatment of various cancers. Mesothelioma could be next.
Gene Therapy
Aims to treat or prevent cancer by injecting genetic material into the body. One form called suicide gene therapy uses a modified virus in combination with a drug the cancer activates to target and kill cancer cells. Gene therapy is particularly useful for pleural mesothelioma patients given the accessible location of the tumors.
Photodynamic Therapy
Uses light energy to kill cancer cells. Doctors inject a light-sensitive drug into the patient. After a few days, a special light is applied to the area, usually via laser, to activate the drug and kill cancer cells.
The advantage of being in a trial is having a whole team looking after you, and not just your doctor. It’s our whole research team looking after a patient.”
Complementary and alternative medicine (CAM) options don’t treat the disease itself but focus on the patient mentally, emotionally and physically. They can be used alongside more traditional approaches to cancer treatment. These types of treatments are not replacements to modern medicine and should not be used in place of a doctor or other medical professional.
Massages, acupuncture, yoga, naturopathy and aromatherapy can be used to relieve pain or reduce stress that comes from traditional treatment. Patients in many states have access to medical marijuana, which can help control cancer pain.
Mesothelioma Treatment Timeline
The treatment timeline a patient goes through varies depending on the type and stage of the cancer.
The following are steps a mesothelioma patient may experience.
Diagnosis
The doctor usually delivers a diagnosis two to three months after symptoms appear.
Biopsy
Doctor orders a biopsy and recommends a specialist to the person diagnosed. Biopsy confirmation can take up to 10 days.
Appointment with Specialist
It usually takes a week for a surgeon or oncologist to meet with the person diagnosed after biopsy confirmation.
More Tests
Surgeon or oncologist orders additional biopsies, X-rays, CT scans, MRIs, PET scans, stress tests and other examinations to determine stage and surgery eligibility.
Treatment Plan
If the patient is eligible for surgery, the surgeon will schedule the procedure, depending on their availability.
Chemotherapy and radiation therapy may be delivered before, during or after surgery.
Follow-up CT scans track the success of surgery and determine if additional treatments are needed.
Doctor creates a pain management plan to help the patient cope with discomfort following surgery.
If patient is not eligible for surgery, they will schedule an appointment with an oncologist for other treatment options, including chemotherapy and radiation.
A patient receives chemotherapy within first few days. Chemotherapy may be delivered in three to four rounds every 21 days.
Follow-up CT scans are ordered to see progress.
More chemotherapy rounds may be ordered, or the oncologist may recommend further modifications, including other combination of treatments.
Leading Mesothelioma Treatment Specialists
The top specialists work at recognized mesothelioma centers. Some of the best known mesothelioma specialists, such as Dr. David Sugarbaker at the Lung Institute at Baylor College of Medicine in Houston, trained young surgeons who have moved on to other cities and treatment centers.
Dr. Jacques Fontaine at the Moffitt Cancer Center in Tampa and Dr. Abraham Lebenthal at Brigham and Women’s Hospital in Boston took Sugarbaker’s expertise to others around the country.
What Is the Average Cost for Mesothelioma Treatment?
Mesothelioma treatment can be expensive if you don’t have health insurance or financial resources. Cost is difficult to pinpoint because every case is unique.
The average cost of lung cancer treatment, which is comparable to mesothelioma, is $60,709 during the initial year after diagnosis, according to recent projections from the National Cancer Institute.
$60,709
According to recent projections, this is the average cost of lung cancer treatment, which is comparable to mesothelioma, during the initial year after diagnosis Source: National Cancer Institute
Chemotherapy costs vary depending on the type of cancer, the drugs used and patient-specific factors. The total cost for pemetrexed (Alimta) plus cisplatin — the most used chemotherapy combination for first-line treatment of mesothelioma — was $40,102, according to a 2013 cost effectiveness study comparing the drug pair with other chemotherapy regimens.
The estimated monthly cost of radiation therapy is $2,000; however, the total expense depends on your health coverage and the number of treatments you receive. According to a 2015 study published in the Journal of Oncology Practice, the median cost of a course of radiation therapy for lung cancer patients was $9,000.
Matt Mauney is an award-winning journalist with nearly a decade of professional writing experience. He joined Asbestos.com in 2016, and he spends much of his time reading, analyzing and reporting on mesothelioma research articles to ensure people in the mesothelioma community know the latest medical advancements. Prior to joining Asbestos.com, Matt was a reporter at the Orlando Sentinel. Matt also edits some of the pages on the website. He also holds a certificate in health writing from the Centers for Disease Control and Prevention.
Shah, M. et al. (2013, August 7). Cost effectiveness of first-line pemetrexed plus platinum compared with other regimens in the treatment of patients with nonsquamous non-small cell lung cancer in the US outpatient setting. Retrieved from http://www.sciencedirect.com/science/article/pii/S0169500213003309
