Traditional Treatments

While there is currently no known cure for malignant mesothelioma, treatments are available with the most common being surgery, chemotherapy and radiation therapy. Doctors will often use two or more of these treatment courses jointly to provide the maximum likelihood of success. This “multimodal” approach holds the most promise for survival of malignant mesothelioma patients. Trimodality therapy, in which all three of these modalities are used, is considered the most effective aggressive approach.

Your doctor will recommend one treatment or a combination of therapies that are best for your situation. The course of treatment will depend on a number of factors including the location of the disease, the stage of the disease, your age, overall health and your preferences. 

Surgery

There are several types of surgeries used to treat mesothelioma and the disease type and stage will determine the type of surgery. Mesothelioma tumors are usually large and difficult to completely remove, so surgery is usually combined with other cancer treatments to ensure the best results in destroying the tumor. 

There are two main types of surgical treatment for pleural mesothelioma: extra-pleural pneumonectomy (EPP) and pleurectomy/decortication. EPP is the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. Pleurectomy/decortication removes the pleura without removing the entire lung. Since EPP and pleurectomy/decortication are not frequently performed by most surgeons, patients are referred to centers specializing in these treatments. Many of these centers also specialize in other forms of mesothelioma treatment, either alone or in combination (multi-modal therapy.) Your doctor can discuss referrals. 

Radiation therapy

Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation). While there may be side effects from radiation, most of these will go away after a short while. 

In pleural mesothelioma, it is difficult to irradiate tumor tissue successfully without injuring nearby organs like the lungs, heart, and liver. However, radiation therapy can be very effective in relieving pain in certain situations.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle. Researchers are also studying the effectiveness of delivering chemotherapy directly into the chest or abdomen (intrapleural or intraperitoneal delivery). 

Chemotherapy may be given as the primary treatment to mesothelioma, or it may be used in addition to surgery. To effectively treat mesothelioma, more than one drug may be used. Depending on the drugs, the amount taken and the treatment period, there may be side effects. Historically, doxorubicin has been the most widely used single chemotherapy drug. Other newer drugs, including gemcitabine, cisplatin, carboplatin, epirubicin, cyclophosphamide, ifosfamide, vinorelbine, paclitaxel, and methotrexate, now are often preferred and are usually given in different combinations. 

Recently, the University of Chicago Cancer Research Center released the results of a yearlong clinical trial of Pemetrexed Disodium (Alimta). A clinical study has shown positive results when Alimta was used with vitamins and the traditional chemotherapy drug, Cisplatin, for treating malignant pleural mesothelioma. Because of its ability to reduce tumors, prolong survival and reduce pain, Alimta is available to some pleural mesothelioma patients on a “compassionate use” basis. Patients who have not yet received treatment for mesothelioma may be eligible to obtain Alimta free of charge prior to the Food and Drug Administration’s completion of its formal review of the drug in 2004.

There are several new experimental treatments that try to enhance the immune system's ability to combat malignant mesothelioma. These include gene therapy and the use of cytokine proteins such as interferons and interleukins. These treatments are also being tested in combination with chemotherapy and other treatments.

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Non-Traditional Treatments
Photodynamic Therapy

Photodynamic therapy destroys cancer cells by using the energy from light and may also be effective when combined with surgery. Although this treatment is in the experimental stage for mesothelioma, it has shown promising results in treating other cancers. In the procedure, the patient receives a photosensitizer (a drug which makes cells sensitive to specific wavelengths of light) which collects in cancerous cells but not in healthy cells. Once the cells have been sensitized, fiber optic cables are placed in the body (usually through open-chest surgery) so that the correct frequency of light can be focused on the tumor. This causes the photosensitizer drug to produce a toxic oxygen molecule which kills the cancer cell. 

Gene Therapy

This is a new treatment, currently in clinical trails. This approach allows treatment to target tumors, rather than destroying healthy cells which is the negative of traditional chemotherapy. In gene therapy, cancer is treated by altering genetic defects that allow a tumor to develop. A “suicide gene” is inserted directly into the tumor, making the cells sensitive to a normally ineffectual drug. The drug is then administered to the newly sensitive cancer cells and it destroys those cells while leaving the healthy cells unharmed. 

Gene therapy for mesothelioma is being researched at the University of Pennsylvania.

Immunotherapy

Immunotherapy (or biological therapy) treats cancer by using the body’s own immune system fight cancer cells. Another name often applies to this therapy, biological response modifiers (BRMs). Though not yet obtainable, promising clinical studies are underway for immunotherapy. 

In addition to traditional forms of treatment, some cancer patients are turning to the alternative medicine’s healing philosophies and spiritual approach to living with the disease. 

The Preventable Disease

Manufacturers have known the hazards of asbestos 1920s and substitute materials have been available since that time. Yet corporations did not inform workers of asbestos’ inherent dangers. If you have been diagnosed with mesothelioma, your health is your highest priority. However, financial concerns may be increasing your burden. There may be help in the form of compensation for medical costs, loss of wages and other important considerations. We would like to help you ease your monetary concerns. Please call Belluck & Fox toll-free at 1-877-NYLAW08 to discuss your situation

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RESOURCES for those with Mesothelioma

New York Mesothelioma Specialists

Manjit S. Bains, M.D., F.A.C.S., Thoracic Surgery at the Memorial Sloan-Kettering Cancer Center in New York City.
http://www.mskcc.org/prg/prg/bios/48.cfm 

Philippe A. Chahinian, M.D., Mount Sinai Hospital, New York City.
http://www.mountsinai.org/common/detail.jsp?nav=dd
&hosp=msh&Doctor_ID=774&alpha=1 

Mary Louise L. Keohan, M.D., Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons/New York Presbyterian Hospital, New York, NY
Phone: (212) 305-4076

Roman Perez-Soler, M.D., Associate Director of Clinical Oncology/New York University Kaplan Cancer Center, New York, NY
Phone: (212) 263-8043

Carrie A. Redlich, MD, MPH, Associate Professor of Occupational and Environmental Medicine, Yale University School of Medicine, New Haven, Connecticut.
http://info.med.yale.edu/intmed/cardio/occmed/redlich/
redlichcv.html#Address 

Valerie Rusch, M.D., F.A.C.S., Alfred P. Sloan Chair at the Memorial Sloan-Kettering Cancer Center in New York City.
http://www.mskcc.org/prg/prg/bios/51.cfm 

Robert N. Taub, M.D., Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons/New York Presbyterian Hospital, New York, NY
Phone: (212) 305-4076

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NEW YORK TREATMENT CENTERS

Roswell Park Cancer Institute, Mesothelioma Treatment Section 
716-845-5873 

Memorial Sloan-Kettering Cancer, Mesothelioma Treatment Section 
212-639-6483 

Department of Surgery, Columbia Presbyterian Medical Center Mesothelioma Treatment Section 
212-305-9468 

Columbia-Presbyterian Medical Center, Herbert Irving Comprehensive Cancer Center 
Mesothelioma Treatment Section 
212-305-1252 

New York Presbyterian Hospital, Mesothelioma Treatment Section 
212-746-2844 18 

CCOP-Syracuse Hematology-Oncology Associates of Central New York, Mesothelioma Treatment Section 
315-472-7504 

Regional Cancer Center Mesothelioma Treatment Section 
315-464-8200

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