Monday, 12 October 2015

What is the conventional approach to treating mesothelioma?


            What is the conventional approach to treating mesothelioma?

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined. Standard treatment for all but localized mesothelioma is generally not curative. 1 (See survival rates for median survival rates with different treatments.)

Surgery – Extrapleural pneumonectomy in selected patients with early stage disease may improve recurrence-free survival, but its impact on overall survival is unknown. Pleurectomy and decortication can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumor. Operative mortality from pleurectomy/decortication is <2%, while mortality from extrapleural pneumonectomy has ranged from 6% to 30%. 2

Radiation/Chemotherapy – The use of radiation therapy in pleural mesothelioma has been shown to alleviate pain in the majority of patients treated; however, the duration of symptom control is short-lived. Single-agent and combination chemotherapy have been evaluated in single and combined modality studies. The most studied agent is doxorubicin, which has produced partial responses in approximately 15% to 20% of patients studied. Some combination chemotherapy regimens have been reported to have higher response rates in small phase II trials; however, the toxic effects reported are also higher, and there is no evidence that combination regimens result in longer survival or longer control of symptoms. 3

Alimta – The only FDA approved chemotherapy for malignant pleural mesothelioma (in combination with cisplatin) is pemetrexed (Alimta). In the key clinical trial that led to its approval, Alimta was combined with another chemotherapy drug (cisplatin) and compared with cisplatin alone. The patients who received the two drugs (Alimta and cisplatin) had their cancers progress (grow/spread) in 5.7 months (median). The patients who only received cisplatin had their tumors progress in 3.9 months (median). The median survival for the patients who received both drugs was 12.1 months versus 9.3 months for cisplatin only. 4

For some physicians, these therapeutic gains are not impressive. For example, some have written, “For the treatment of mesothelioma, there is little evidence that current therapies (chemotherapy, radiation, surgery) provide significant benefit for survival or quality of life.[R]adical treatments, occupying the 3 months after diagnosis, can take up the best 3 months that the patient might have had.Malignant mesothelioma has largely defeated treatment…”5


Unless otherwise indicated by an endnote, the above material was adapted from National Cancer Institute Cancer Facts – Mesothelioma: Questions and Answers 5/13/2002.

1 National Cancer Institute Malignant Mesothelioma (PDQ®): Treatment; Health Professional Version – Treatment Option Overview available here on September 30 , 2005.

2 Id.

3 Id.

4 Vogelzang NJ, et al., Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma . J Clin Oncol. 2003 Jul 15;21(14):2636-44.

5 Treasure T, Sedrakyan A., Pleural mesothelioma: little evidence, still time to do trials . Lancet. 2004 Sep 25-Oct 1;364(9440):1183-5.

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