Mesothelioma Treatment Options

Mesothelioma is an aggressive disease that often requires an equally aggressive treatment strategy. However, mesothelioma is resistant to many standard cancer treatments, making it a difficult disease to manage.

Most often a mesothelioma treatment plan consists of chemotherapy or immunotherapy. For patients who are candidates, surgery and radiation will also be used in a multi-modal approach. Patients should work closely with their medical team to develop a treatment plan that is tailored to their needs and treatment goals.

Even though there is no cure for mesothelioma, treatment strategies are referred to as either curative or palliative in intent. Our mesothelioma lawyers can help you connect to experts who can prescribe the best treatment options for you.

Curative treatments attempt to cure or control the disease, while palliative care is aimed at relieving symptoms and keeping the patient comfortable and surrounded by loved ones without treating the cancer itself.

If you or a family member has been diagnosed with mesothelioma, lung cancer, or another asbestos-related disease, it is important to understand your options. Our respected mesothelioma lawyers at Belluck Law, LLP can provide you with information you need to make the best decision for you and your family. Call us today for a free consultation or visit our New York office.

Cure for mesothelioma includes:

Surgery

Not all patients are good candidates for surgery. Published data suggests that in order to derive benefit from surgery, patients should have favorable prognostic characteristics such as good general health, early disease stage, and primarily epithelioid histology. The two primary curative surgeries for mesothelioma patients are pleurectomy/decortication and extrapleural pneumonectomy (EPP).

• Pleurectomy/decortication (P/D). This surgery is sometimes referred to as the “lung-sparing” surgery. The surgery involves stripping away the diseased membrane lining the lung and visible mesothelioma tumors while saving the lung.
• Extrapleural pneumonectomy (EPP). EPP is the alternative to P/D for pleural mesothelioma patients. This surgery is considered a more radical procedure that involves removal of a lung, the diseased lining of the chest cavity and heart, and a portion of the diaphragm.

Palliative surgical procedures focus on relieving symptoms that are impacting a patient’s quality of life, but they do not focus on curing the cancer. Debulking pleurectomy and pleurodesis are two procedures often used in conjunction to improve the breathing for a patient. The pleurectomy eases pressure on the lungs by stripping cancer cells from the pleura. A pleurodesis is then performed to fuse the pleura and limit fluid build-up.

Chemotherapy

Chemotherapy is one of the primary treatment modes for mesothelioma. Chemotherapy, a strong medicine used to kill cancer cells, is delivered via an infusion in cycles over a period of several months.

Unfortunately, chemotherapy drugs don’t distinguish between cancerous and normal cells, and they kill off healthy cells as well. As a result, patients who undergo mesothelioma chemotherapy commonly experience side effects, including anemia, nausea or other digestive disruption, and, in rare occasions, hair loss.

The most common chemotherapy treatment for mesothelioma is the combination of Alimta (pemetrexed), which was approved by the U.S. Food & Drug Administration in 2004, and cisplatin, a long- standing staple of many chemo treatments.

An anti-VEGF agent called bevacizumab can be added to the chemotherapy regimen. This class of drug inhibits the development of vascular structures that bring nutrients to the tumor, thus starving it.

Immunotherapy

“Immunotherapy is a new class of cancer treatment that works to harness the innate powers of the immune system to fight cancer,” according to the Cancer Research Institute. . Mesothelioma is a cancer that genetically resembles normal tissue in the body. Moreover, the mesothelioma tumor microenvironment and its cancer cells are good at evading immune reactions. Immunotherapy makes the cancer visible to the immune systems and allows it to react against it. Generally speaking, patients deriving most benefit from immunotherapy are those with the predominantly sarcomatoid mesothelioma. Although immunotherapy is a needed new addition to the mesothelioma treatment arsenal, it is not harmless. Side effects from immunotherapy can be severe and can result in autoimmune disorders, dangerous inflammation of the lungs or other organs, or sometimes less dangerous but still uncomfortable rashes, gastrointestinal disturbances, and even unexpected symptoms.
In 2022, the second ever FDA approval came for an immunotherapy treatment consisting of a combination of two drugs: nivolumab and ipilimumab (also known by brand names Opdivo/Yervoy):

More recently, Keytruda (pembrolizumab) also received FDA-approval in conjunction with chemotherapy for the treatment of advanced mesothelioma.

Both of these immune treatments are called checkpoint inhibitors because they bind to either the PD-L1 biomarker found on the surface of the cancer cells or the PD-1 marker found on T cells this inhibiting the cancer from binding to the T cell. Preventing the tumor’s PD-L1 protein from binding to the T cells receptor tells the immune system that the tumor should be destroyed.

Radiation

Radiation therapy uses high-energy ionizing radiation to kill cancer cells. Ionizing radiation changes the structure of DNA in cells, thus inhibiting growth and division.

Radiation is used in most cases of mesothelioma. However, pinpointing the malignant cells is difficult, resulting in damage to healthy cells as well. The side effects of radiation are similar to those for chemotherapy and include hair loss, digestive problems, and anemia.

Recent breakthroughs in the use of proton therapy, which uses a beam of protons to irradiate the tumors, as opposed to X-ray beams used in conventional radiation therapy, are allowing physicians to target deep-seated tumors with greater precision, limiting damage to the surrounding tissue.

Mesothelioma Clinical Trials

According to the National Institutes of Health, clinical trials are at the heart of all medical advances. Clinical trials serve to uncover better ways to treat, prevent, diagnose and understand human disease. They provide mesothelioma researchers with critical information needed to allow them to move their findings from the lab to patients. For some mesothelioma patients, clinical trials offer an opportunity to try a treatment that is not otherwise available.

There are benefits and risks to participating in clinical trials. In the U.S., clinical trials are closely monitored and are run according to strict guidelines. The NIH explains that federally funded clinical research has safeguards in place to protect the participants. Deciding whether to enter into a clinical trial is a patient’s personal choice, and the benefits and risks should be carefully weighed.

Mesothelioma patients are encouraged to work closely with their doctors to determine the best treatment plan for their needs. The treatment plan you and your doctor develop will depend on several factors, including the type and stage of disease, and your overall health.

Mesothelioma is one of the most aggressive cancers, and, as a result, is one of the most challenging to treat. Surgery, chemotherapy and radiation are the primary treatment protocols; however, while these treatments can relieve symptoms, they do little to improve survival. When patients are diagnosed with the terminal cancer, they are often given just a year to live.

Recent breakthroughs in cancer research in general have meant an improvement in survival of mesothelioma patients.

Patients in clinical trials often have higher survival as they benefit from the current research to bring new, effective treatments to patients. Mesothelioma patients in clinical trials have access to treatments that may not otherwise be available to them.

What is a clinical trial, and is it right for me?

The National Cancer Institute describes clinical trials as “the final step in a long process” that starts with a lot of research in a laboratory and tests on animals. The clinical trial portion of the process involves testing the treatment on real human patients to determine whether or not it is effective and safe. The hope is always that the treatment will help the patients, but there is a risk that it could be harmful or have no effect.

Mesothelioma clinical trials may include a variety of treatment options, and not all patients who participate will be trying a brand-new treatment. As ClinicalTrials.gov explains, trials may include:

• Testing new drugs or medical devices.
• Trying new medical procedures.
• Experimenting with changes to patients’ behavior, such as diet.
• Comparing a new medical approach to a standard one.
• Comparing a new treatment to a placebo (which contains no active ingredients).
• Comparing two treatments that are already available.

Talk to your doctor and medical team about the potential risks and rewards of participating in a mesothelioma clinical trial. Also consider talking to other patients who have participated in these types of clinical trials and research to get their perspectives.

Who pays for clinical trials? Are there costs for patients who participate?

In most cases, patients do not pay to participate in the trials themselves. The costs of the research done in the clinical trial are often covered by the government, nonprofit agency, or company that is sponsoring the mesothelioma clinical trial, according to the National Cancer Institute.

However, patients may still be on the hook for routine medical costs that they would have incurred even if they were not participating in a clinical trial, such as regular doctor visits and exams. The National Cancer Institute warns that patients should check with their insurance plans before participating in a mesothelioma clinical trial because some plans won’t cover routine medical costs if a patient is part of a trial. Patients also need to take into account the potential expense of traveling and lodging during a mesothelioma clinical trial.

What are the stages of a mesothelioma clinical trial?

The Food and Drug Administration (FDA) oversees the approval process for medical treatments in the United States. Once a drug has been developed and tested on animals, the drug’s sponsor submits an application to the FDA to start the clinical trial process, which includes four phases:

• Phase 1: About 20 to 80 healthy people are usually chosen for phase 1 of a clinical trial, where the goal is to identify common side effects and how the drug is metabolized and excreted. This phase focuses on safety.
• Phase 2: Hundreds of people are chosen to participate in phase 2 of a clinical trial, which focuses on the treatment’s effectiveness. In this phase, participants with mesothelioma receive the treatment and, in many cases, the effectiveness will be measured against other patients who are receiving a placebo or different treatment.
• Phase 3: At this stage, the clinical trial is expanded to include even more participants. The goal is to study the safety and effectiveness among various populations, using different dosages and testing the drug in combination with other drugs.
• Phase 4: This phase actually occurs after the FDA has approved a drug for marketing. Doctors and patients continue to report side effects, and the sponsor (which is usually the manufacturer of the drug) is required to provide updates to the FDA as new information about the drug’s effects is discovered.

How can a patient qualify for a mesothelioma clinical trial?

If you are interested in participating in a mesothelioma clinical trial, start by talking to your doctor about your options. You will first need to know specific details about your mesothelioma diagnosis that you can compare to the eligibility criteria for any trials you are interested in. The National Cancer Institute offers a Cancer Detail Checklist that you and your medical team can fill out to get started.

When looking for treatment clinical trials for malignant mesothelioma, there is no one-stop shop that lists them all. Trials can be sponsored by the government, nonprofit agencies, pharmaceutical companies, and medical centers with researchers on staff. However, here are a few good places to start your search:

When you find a mesothelioma clinical trial that you are interested in, the National Cancer Institute suggests you print a copy of the clinical trial summary, which should explain the basic details of the trial and where it is taking place.

What questions should I ask my doctor?

You should always learn as much as you can about a mesothelioma clinical trial before deciding whether to participate in it. You have a right to ask your doctor and the research team about all aspects of the study, the medications or procedures involved, and any related expenses.

ClinicalTrials.gov suggests that patients ask the following questions when considering participating in a clinical trial:

• What exactly is being studied, and what will I have to do?
• What tests and procedures are involved?
• How often will I have to visit the hospital or clinic? Will hospitalization be required?
• Why do researchers think the intervention being tested might be effective? Why might it not be? Has it been tested before?
• How do the possible risks, side effects, and benefits of this trial compare with those of my current treatment?
• What are the possible interventions that I might receive during the trial? And how will that be determined (for example, by chance)?
• Who will oversee my medical care while I am participating in the trial?
• What will happen if I am injured during the study?
• How long will the study last?
• Who will pay for my participation? Will I be reimbursed for other expenses such as travel?
• If I benefit from the intervention, can I continue receiving it after the trial ends?
• What type of long-term follow-up care is part of this trial?
• Will results of the study be provided to me?

Finding Hope Through Mesothelioma Research

Whether you’ve just been diagnosed with mesothelioma or are well into your treatment journey, know that doctors and researchers are constantly searching for more and better alternative treatment options through clinical trials. And remember, most of the effective treatments we take for granted today were first tested in clinical trials.

If you or someone you love has been diagnosed with mesothelioma , let the dedicated asbestos lawyers at Belluck Law, LLP work for you and your family.  We have locations at New York City and across the state. Contact us for a free consultation so you’re informed about your rights. We can also connect you with mesothelioma medical experts, if needed.

SMART Treatment

The ‘Surgery for Mesothelioma After Radiation Therapy’ study, conducted by researchers at Princess Margaret Cancer Center in Toronto, more than doubled three-year survival rates of mesothelioma patients who underwent radiation therapy followed within a week of an extrapleural pneumonectomy surgery to remove the lung. The SMART approach consists of irradiating the chest area in an effort to localize the tumors as much as possible prior to surgery. However, aggressively irradiating the lung in such a manner, while shrinking the cancer also causes severe life-threatening pneumonitis. For this reason, the protocol requires that the lung be removed by an EPP procedure within two weeks of radiation therapy.

The survival rates improved to 72%, from 32%, and the patients experienced “shorter treatment, fewer complications and speedier recovery,” according to Dr. John Cho, radiation oncologist and partner in the study.

The SMART approach also reduced the risk of recurrence, according to the researchers, because the radiation halted the mesothelioma cancer cells ability to seed itself elsewhere in the chest or abdomen during surgery.

“These research results offer real hope to mesothelioma patients who have too often been told in the past that they may have only six months to live,” say the researchers.

Since the study was published in 2014, two new studies have continued the inquiry along the same lines with the SMARTER and finally the SMARTEST study which incorporates immunotherapy into its treatment protocol.

Other Therapies Under Investigation Available in a Clinical Trial Setting

• Pegargiminase plus first-line chemotherapy in patients with nonepitheliod pleural mesothelioma – this treatment has been tested in a Phase 3 randomized clinical trial that found that arginine depravation improves survival in patients with the most aggressive sarcomatoid and predominantly sarcomatoid mesothelioma.
• Volrustomig is a dual activity agent akin to the nivolumab/ipilimumab combination. It is currently being tested globally.
• Therapies that target mutations within the tumor, that aren’t necessarily unique to mesothelioma.