Conventional Treatments for Mesothelioma
Surgery may be used in both pleural and peritoneal mesothelioma patients. Surgeons usually prefer to provide a surgical procedure when the cancer is localized and debulking of the tumor is practical. Today, many mesothelioma specialists use heated chemotherapy in conjunction with surgery. During the actual procedure heated chemotherapy can be introduced into the surgical cavity to bathe any macro or micro metastasis that the surgeon was unable to excise. In this way, the cytotoxic effects of chemo can be imparted directly to the tissues where it is most needed.
There are different types of surgeries including lung sparring surgery and extrapleural pneumonectomy (EPP). In lung sparring surgery, surgeons remove the diseased membrane lining the lung and any visible mesothelioma tumors, but spare the lung. Extrapleural pneumonectomy (EPP) is a more radical surgical procedure that involves removal of the diseased lung, part of the pericardium, (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest). EPP is an invasive and complex operation.
Chemotherapy, also referred to as systemic therapy, includes oral and intravenous cytotoxic (cell-killing) medications to kill the cancerous cells. These drugs kill both cancerous as well as healthy cells. Some of the most commonly used chemotherapy drugs to treat mesothelioma are cisplatin and pemetrexed. In fact cisplatin and pemetrexed (brand name Alimta) in combination is the only FDA approved chemotherapy for mesothelioma.
Radiation may be an important part of mesothelioma treatment and it can be delivered through various methods. But if the cancer strikes near lungs and heart, it can be challenging for doctors to provide just the right dose for the intensive therapy required to reduce the tumor without creating associated morbidities. There is a newer option, IMRT or intensity-modulated radiotherapy that can target cancer cells more accurately and avoid the healthy cells. When performed by experienced clinicians, one may expect better results with fewer side-effects.
In addition to these modalities, there are many clinical trials today that focus on newer approaches to mesothelioma. These include various biological response modifiers such as anti-angiogenesis. Decades ago, Dr. Judah Folkman discovered that tumors need an expanding network of blood vessels in order to continue growing. The blood vessels brought oxygen and nutrients to the cancer cells and without the blood vessels the tumor would be starved of what it needed to continue growing. Folkman hypothesized that cutting off the tumor’s ability to create new blood supplies (angiogenesis) would be an effective and perhaps less toxic approach to cancer treatment.
Over the last decade, universities and biotech companies have been hard at work identifying, synthesizing and administering anti-angiogenesis drugs – drugs designed to stop the angiogenesis of new blood vessels. There has been some limited success in a number of cancers including mesothelioma. Anti-angiogenesis drugs used in mesothelioma include: bevacizumab, tyrosine-kinase inhibitors and other agents. Today, researchers are still attempting to make this modality effective in mesothelioma but have admitted that the clinical use of angiogenesis inhibitors has been more challenging than anticipated.
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