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Mesothelioma Treatment
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MESOTHELIOMA CANCER TREATMENT
Doctors specializing in mesothelioma cancer treatment frequently adopt a multimodal approach: they treat a patient with a combination of therapies. Due to the relative lack of effectiveness of single-modality treatment in affecting patient survival, the multimodal combination of treatments holds more promise for survival of mesothelioma cancer patients.
The December 1999 issue of the medical journal, Chest, published a clinical case presentation that illustrates a fairly typical multimodal treatment. The patient was a 52-year-old man with an early diagnosis of Stage I pleural mesothelioma cancer. Doctors performed a pleurectomy (i.e. surgery) and then delivered intrapleural doses of chemotherapy drugs. Then he received additional localized radiation and chemotherapy. Two years after the surgery he did not show evidence of the tumor.
In recent years, there has been some progress made in the management of mesothelioma cancer, particularly in the area of combination of agents and treatment methods used.
Drug Therapy
Chemotherapy is the traditional approach using anti-cancer medicines to kill malignant cells. This is often used in addition to surgery or in combination with radiation therapy or immunotherapy. Thus far these strategies have met with limited success in treating mesothelioma cancer.
Some specific drugs that have been developed to treat mesothelioma cancer include Alimta, Lovastatin, Megace, Onconase and Vinorelbine. More information on these treatment options are available on the pages linked.
Angiogenesis
Cancer cells rely for their growth on a rich supply of blood. They must be surrounded by an effective network of capillaries and larger blood vessels that nourish the cells. The medical term for the process of developing this network is angiogenesis. Fast-growing cancer cells are highly efficient at promoting angiogenesis, enabling the tumor to grow and spread.
A number of antiangiogenesis drugs, also called angiogenesis inhibitors or angiogenic inhibitors, have been developed in an attempt to slow down, stop or reduce angiogenesis. When administered to laboratory animals with tumors, they have caused the tumors to shrink or even disappear.
A few of these drugs are now being tested on humans. This area of cancer research holds promise for the treatment of mesothelioma cancer tumors, but it is very much in the early and experimental stages.
Gene Therapy & Immunotherapy
Immunotherapy is based on the theory that it is possible to mobilize the body's own immune defenses against cancerous cells. There are several experimental treatments that try to enhance the immune system's ability to combat mesothelioma cancer. 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.
Gene therapy works by using an adenovirus for delivery, with a "suicide gene" inserted directly into the tumor. This gene makes the cells sensitive to a normally ineffective drug, such as glanciclovir. Treatment with the drug then destroys those cells that are rapidly dividing - which are the cancer cells - leaving the healthy cells unharmed.
In theory, this approach allows treatment to target the tumor specifically, as opposed to treatments such as chemotherapy which also kill healthy cells.
Cytokines are small proteins that occur naturally in the human body. They are similar to hormones and have specific effects on the behavior of other cells.
Interferons are also naturally occuring cytokine proteins, but they inhibit the growth of malignant cells as well as enhance the immune system. Like interleukins, these immune system promoters are being tested to see if they help increase the body's response to what is often an extremely resistant malignancy, mesothelioma cancer.
Photodynamic therapy
Photodynamic therapy (PDT) is a treatment method often used in combination with other treatments, such as drugs or surgery. PDT uses light to kill cancerous cells and is still in an experimental stage for treatment of mesothelioma cancer.
Radiation
This treatment involves the localized use of high-dose radiation on malignant tumors. Usually, it is not a primary treatment but is used in conjunction with other therapies such as surgical resection and chemotherapy. It is generally used to reduce the size of the symptomatic tumor and help relieve symptoms like pain and shortness of breath. Use of radiation for treatment can be limited by factors such as volume of the tumor and proximity to vital organs.
Surgery
There are two types of surgical treatment for pleural mesothelioma cancer: extra-pleural pneumonectomy (EPP) which involves removal of the pleura, diaphragm, pericardium and lung that are involved with the tumor and pleurectomy/decortication which involves removal of the pleural alone. Treatment recommendations depend on the factors of the case.
Surgery can provide symptomatic relief and sometimes the bulk of the tumor can be removed. Surgery is often used in combination with other treatments (known as multi-modal treatments), but its value is very limited if the tumor is near any vital organs.