How Do Doctors Determine Treatment Plan?
An oncologist chooses a treatment plan for the patient based on several factors, including the site and stage of mesothelioma. Many mesothelioma patients follow a multimodal treatment plan, which involves several types of therapy that work together.
Specialists perform specific tests to determine where the cancer has spread, how serious the prognosis is, and if the patient is eligible for curative treatment options. Tests may include:
- CT scans of the chest and abdomen
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
Different medications may be used for different purposes. For example, some drugs are designed to shrink tumor cells, while others slow the spread of cancer cells. Patients who are not eligible for surgery can receive other medications to help alleviate pain or increase the quality of life. Mesothelioma medications vary and new treatments are continually researched and tested in clinical trials.
Mesothelioma patients typically undergo chemotherapy to effectively treat their cancer. However, doctors may distribute other anti-cancer drugs in combination with chemotherapy or as a standalone treatment. Medications generally used to treat mesothelioma include:
- Emerging drugs
- Photodynamic treatment
- Targeted treatment
Chemotherapy drugs work by slowing or stopping cancer cells from dividing. They are often paired with other medications to ensure maximum effect. The combination of chemotherapy with surgery has been the most successful form of treatment for mesothelioma. Chemotherapy medications used to treat mesothelioma include:
- Gemcitabine (Gemzar)
- Pemetrexed (ALIMTA ™)
Depending on how far the cancer has metastasized, or spread, doctors can administer chemotherapy to mesothelioma patients through pills, infusions (systemic chemotherapy), or directly to the affected organ (intrapleural or intraperitoneal chemotherapy).
If the mesothelioma tumors are small enough, chemotherapy can be used as a standalone treatment. However, many patients receive chemotherapy in combination with surgery or radiation, or as a palliative treatment designed to relieve cancer symptoms.
Side Effects of Chemotherapy
Since the purpose of chemotherapy is to slow cell division, some healthy cells can be affected. As a result, patients receiving chemotherapy may experience some side effects, including:
- Increased chance of infections, bruising or bleeding
- Loss of appetite
- Loss of Hair
- Sores in the mouth
- Vomiting and Nausea
While side effects usually go away after the treatment cycle is complete, there are other medications that can ease the effects of chemotherapy. Talk to your doctor about your options for relieving chemotherapy side effects.
Photodynamic therapy (PDT) combines a photosensitizer agent and a light to target and eliminate cancer cells. When photosensitizers are exposed to certain wavelengths of light, a formation of oxygen kills the cancer cells. PDT has previously shown prognosis improvement in many mesothelioma patients.
Side Effects of Photodynamic Treatment
Porfimer sodium, a substance used during this process may make the eyes and skin hypersensitive to light for about six weeks after treatment ends. Patients who undergo PDT should stay away from direct sunlight and bright indoor lights during that time.
Immunotherapy is a form of treatment that stimulates the patient’s immune system to attack cancerous cells. This biologic therapy emerged as a treatment for mesothelioma in 2010.
Immunotherapy can alleviate cancer symptoms and improve survival rates. Researchers are still testing immunotherapy treatments through clinical trials. Current studies are testing several immunotherapy drugs, including:
- Atezolizumab (Tecentriq™)
- Durvalumab (IMFINZI®)
- Ipilimumab (Yervoy®)
- Nivolumab (OPDIVO®)
- Pembrolizumab (KEYTRUDA®)
Doctors can administer an immunotherapy drug using several different methods, including:
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors are medications that allow the immune system to locate and eradicate cancer cells. Doctors administer immune checkpoint inhibitors through vein injections.
Vaccines trigger an immune response against diseases like mesothelioma. Vaccines are often used in cancer treatment and prevention.
Non-specific immunotherapies strengthen the immune system and encourage it to attack cancer cells.
Patients who receive immunotherapy often experience fewer side effects, unlike traditional chemotherapy, which attacks both healthy and cancerous cells. Instead, immunotherapy directly targets the body’s defenses and enables white blood cells to locate and kill cancer cells.
Side Effects of Immunotherapy
Some patients receiving immunotherapy for mesothelioma treatment may experience some mild side effects, including:
- Nausea or vomiting
- Shortness of breath
- Skin rash or blisters
- Weight loss
To prevent compromising healthy cells, targeted therapy attacks cancer-specific genes, proteins, or the tissue environment that aids in cancer growth and survival. Different types of targeted therapy include:
Anti-Angiogenesis Therapy and Medications
Angiogenesis is a physiological process in which the body creates new blood vessels and is healing and growing normally. When someone has cancer, angiogenesis also helps cancer cells multiply and spread. When new blood vessels form, blood brings nutrients and oxygen to the tumors and enables them to grow.
Anti-angiogenesis blocks angiogenesis by stopping the growth of new blood vessels and starving the tumors the nutrients they need to spread. Angiogenesis inhibitors, also known as small-molecule drugs, include:
- Bevacizumab (Avastin®)
- Ramucirumab (CYRAMZA™)
Monoclonal antibodies are therapies that target receptors on the outside of cancer cells using anti-angiogenesis drugs. The antibodies can attack specific areas on diseased cells. Monoclonal antibodies can also be used in combination with chemotherapy and radiation therapies.
Epidermal Growth Factor Receptor Inhibitors (EGFR)
Epidermal growth factor receptor inhibitors are proteins found on the surface of some healthy cells that are involved in cell growth. Recent studies suggest that blocking EGFR may inhibit or prevent mesothelioma tumor growth. Researchers have been testing multiple EGFR inhibitor medications, including:
- Afatinib (Gilotrif™)
- Gefitinib (Iressa®)
Side Effects of Targeted Therapy
Targeted therapy does less damage to healthy cells and normally attacks specific genes, proteins, or tissues that help cancer grow and spread. However, some less severe side effects may include:
- Headaches and pains
- High blood pressure
- Lost appetite
- Low white blood cell counts and an increased risk of infections
- Mouth Sores
- Nausea or Diarrhea
New treatments must be tested in clinical trials before they are offered to the public.
Before offering new treatments to the public, they must undergo clinical trials, clinical trials are studies conducted with groups of volunteer patients. The goal is to determine if the new medication is safe and effective for human use. Clinical trials can involve emerging treatments or test new versions of current treatments.
Clinical trials allow doctors to research and discover new ways to improve treatments and quality of life in mesothelioma patients. Current mesothelioma clinical trials are testing several drugs, including:
Visit The National Cancer Institute for a complete list of tests and locations.
Radiation therapy involves the use of high-energy particle beams to destroy cancer cells within a targeted area and prevent them from metastasizing. This form of treatment has shown to shrink mesothelioma tumors and relieve any associated pressure and pain. Patients who received radiation therapy have reported fewer side effects than other forms of treatment.
There are no radiation-specific medications, but patients typically receive medication to relieve any side effects of radiation. Anti-cancer drugs, like chemotherapy, are often used prior to receiving radiation therapy, called neoadjuvant therapy.
Patients may receive radiation after surgery to kill any remaining cancer cells. This form of radiation therapy uses high-energy beams from X-rays and protons to target specific areas of the body. This form of treatment can also minimize symptoms for patients diagnosed with late-stage cancer.
Palliative care is a form of treatment for patients with advanced, incurable forms of mesothelioma, or in elderly patients whose bodies may not be strong enough to undergo more invasive treatments, like surgery.
This form of treatment is designed to relieve pain from mesothelioma and its related symptoms. Some patients receive palliative care in combination with curative treatment to provide relief from the side effects of invasive treatments.
Palliative care can include any of the following treatments:
- Complementary Therapies
- Lifestyle Changes
- Pain Medicines