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. (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%.
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.
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.
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..."
Source:
Mesothelioma
