TREATING MESOTHELIOMA

What are the treatment options?

No matter the stage of the cancer, there are treatments for all patients diagnosed with malignant mesothelioma. Treatment depends on the location of the cancer, the stage of the disease, and the patient's age and general health. The three types of standard treatments used are surgery (taking out the cancer), radiation therapy (using targeted high-dose x-rays or other high-energy rays to kill cancer cells), and chemotherapy (using drugs to destroy the cancer). For optimal results, sometimes these treatments may be combined.

During surgery, part of the lining of the chest or abdomen and some of the tissue around it may be removed. For cancer of the pleura, a lung may be removed in an operation called an extrapleural pneumonectomy. In some cases, part of the diaphragm, the muscle below the lungs that aids with breathing, may also be removed. Jai Raman, MD, is one of the expert surgeons treating mesothelioma.

Learn more about Dr. Raman

Radiation

Also known as radiotherapy, radiation uses high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects cancer cells only in the treated area. Radiation is most commonly used after surgery to prevent the cancer from coming back. Local tumor recurrence in the chest remains a common problem for patients with mesothelioma, even following aggressive treatments with surgery and chemotherapy. For this reason, regional chest radiation therapy has been increasingly utilized in recent years to help control residual microscopic cancer cells in the chest. The use of radiation therapy has several potential benefits in select patients, particularly since research has shown mesothelioma cells to be relatively sensitive to radiation. Recent clinical reports from 'tri-modality' treatment regiments (containing surgery, chemotherapy, and radiation) have resulted in very encouraging results. The close collaborative relationship between surgeons, medical oncologists, and radiation oncologists within the University of Chicago program lends itself well to this type of multidisciplinary approach. Radiation oncologist Phillip Connell, MD, is an expert on mesothelioma

Learn more about Dr. Connell

Chemotherapy is the use of anticancer drugs. Most commercially available drugs used to treat mesothelioma are given intravenously (directly into the vein). Some experimental drugs are given orally.

Many chemotherapy agents have been tested in patients with mesothelioma. While a number have performed effectively, but proving their effectiveness has been difficult largely due to the number of patients required. Because the disease is so rare, mesothelioma trials have historically been small in size. This has contributed to the widespread belief that mesothelioma is untreatable. With the development of new, active drugs for mesothelioma that have recently been evaluated in larger clinical trials, we now know that chemotherapy can shrink tumors, decrease symptoms, and prolong life in patients with mesothelioma. Medical oncologists Hedy Kindler, MD, and Ravi Salgia, MD, PhD, are both experts in chemotherapy and novel therapies, such as targeted therapies, for mesothelioma.

More on Standard Chemotherapy

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Targeted agents for mesothelioma

Mesotheliomas have a unique biology that causes them to produce growth factors that stimulate their own growth. Among the most promising treatments are a variety of targeted therapies that block these specific growth factors. These agents have great potential to improve and extend the lives of patients by disrupting cellular processes that contribute to mesothelioma. These agents are being tested alone and in combination with other drugs in several clinical trials at The University of Chicago.

Immunotherapy for mesothelioma

The promise of harnessing the power of the immune system to attack cancer has attracted patients and physicians since the 1920s. The University of Chicago Cancer Research Center has an outstanding program in cancer immunology. Over 30 PhDs and MDs are actively studying ways to harness that power. Although no mesothelioma specific immunotherapy trials are currently underway, trials in kidney, prostate, pancreas, and colon cancer, melanoma and leukemia are paving the way forward. From time to time, immunotherapy trials are opened for mesothelioma patients; for example our most recent trial used an antibody against mesothelin, a protein commonly found on the surface of mesothelioma cells linked to a toxin found in bacteria to create an immunotoxin specific for mesothelioma.

Targeted therapy and immunotherapy are only two of the many new approaches to treating mesothelioma. For an overview of many advanced therapies available at the University of Chicago, please click this link:

Learn more about novel therapies

Dealing with the side effects of treatment

Nausea/vomiting, pain, and depression are common side effects that can all be managed and mitigated.

Nausea and Vomiting - not all chemotherapy drugs or radiation will cause nausea and vomiting. These symptoms, when they occur, can be readily controlled with strong anti-nausea medications.

Pain - very common, but some patients never experience it; those who do, need not suffer. There are many new (and old) pain-killing drugs that will help without significant or extremely disruptive side effects.

Depression - this is a common thing to go through. There are many drugs that can be given which will treat this with minimal side effects.