Treatment of Mesothelioma

Malignant mesothelioma is an aggressive tumor that affects the membranes that cover the abdomen, chest, heart, or testicles. Doctors abroad successfully treat this disease. They perform surgery, use radiation therapy and chemotherapy, and also use the latest types of treatment: immunotherapy, targeted therapy, and hyperthermic intraperitoneal chemotherapy. As part of clinical trials, doctors also use photodynamic therapy, gene therapy, and cancer vaccines. You are welcome to use the Booking Health service to find out the cost of treatment and book your medical care program at the best Cancer Centers in the world.

Content

1. What is malignant mesothelioma?
2. Surgical treatment
   • Treatment of pleural mesothelioma
   • Treatment of peritoneal mesothelioma
   • Treatment of mesothelioma of other localizations
3. Radiation therapy
4. Chemotherapy
5. Immunotherapy
6. Targeted therapy
7. New treatments

What is malignant mesothelioma?

Malignant mesothelioma is a cancer that grows from the mesothelium that covers the inside of the abdominal, thoracic, and pericardial cavities. It produces lubrication and protects the organs.

Pleural mesotheliomas (75% of all cases) and peritoneal ones are the most common. This type of cancer much less often affects the pericardium (near the heart) and the testicles (cancer grows from the funicular process).

There are three types of mesothelioma according to its histological type. These are as follows: 

• epithelioid mesothelioma makes up more than half of all tumors, and this is the most prognostically favorable type;
• sarcomatoid (fibrous) mesothelioma accounts for up to 15% of cases, and this is a more aggressive tumor;
• a mixed type of mesothelioma makes up about a quarter of all cases.

Surgical treatment

For patients with mesothelioma, surgery is considered the best treatment option, as it has the potential to completely cure this type of cancer. If a cure is not possible due to the advanced stage of the disease, palliative surgery may be performed to relieve symptoms.

It is difficult to remove mesothelioma completely, but some major Cancer Centers perform potentially curative surgical interventions. For many patients with mesothelioma, they have been successful: the disease does not recur for many years, which indicates with a high probability that this has been completely cured.

Treatment of pleural mesothelioma

Doctors mainly use two types of operations for pleural mesothelioma. These are as follows:

Extrapleural pneumonectomy is a complete removal of the lung along with the pleura. This option of cancer treatment is used if a surgeon believes that cancer can be cured. In general, pneumonectomy is performed on patients with an operable epithelioid mesothelioma that has not spread to the lymph nodes.

During the operation, the surgeon removes the lung on the side of the lesion along with the pleura lining the chest wall on that side, the diaphragm (a thin respiratory muscle), and sometimes also the pericardium (the sac around the heart), and nearby lymph nodes. The diaphragm and pericardium are then restored with artificial materials.

This is a complex operation that can be performed by experienced surgeons only, in large medical centers. You need a good state of health, fully preserved lung function, and the absence of comorbidities in order to undergo such a surgical intervention.

Pleurectomy or decortication is a less traumatic treatment option for mesothelioma. Doctors remove the entire pleura: visceral and parietal (covering the lung, chest wall, mediastinum, and diaphragm). Nonetheless, the lung remains. The diaphragm and pericardium are preserved in the standard version of this operation, but can be removed as part of an extended pleurectomy.

This operation can be used as a radical one only at an early stage of mesothelioma. In other cases, surgery is performed as a palliative intervention to prevent the accumulation of fluid in the pleura, normalize breathing, and eliminate pain.

Treatment of peritoneal mesothelioma

Surgery for peritoneal mesothelioma is considered cytoreductive (reducing the tumor mass). Surgical treatment may be used to relieve symptoms or to remove tumors from the abdominal wall and organs of the digestive system. As in pleural mesothelioma, these tumors often spread too much for the cancer to be completely cured.

When performing cytoreductive surgery, doctors strive to remove all tumor foci whenever possible, if the patient's health status and the spread of the tumor allow for this. If successful, cytoreduction is considered complete. If tumor foci less than 1 cm remain, cytoreduction is considered optimal.

Treatment of mesothelioma of other localizations

Less commonly, mesothelioma develops in other areas of the body.

Pericardiectomy is a surgical procedure for pericardial mesothelioma. Doctors remove the pericardial sac completely to try to cure the disease. If this is not possible, a surgeon may make a pericardial window: a hole to drain fluid so that it does not accumulate near the heart and compress it. The pericardial window can also be used to inject chemotherapy drugs into the pericardial sac. 

Orchiectomy is a surgical procedure to remove a testicle. This intervention is performed for mesothelioma, which grows from the funicular process. Many patients are initially operated on for an inguinal hernia, and the tumor is discovered only during the operation.

Radiation therapy

Radiation therapy can be used for mesothelioma in the following cases:

• adjuvant therapy reduces the risk of tumor recurrence after cancer surgery;
• palliative care relieves chest pain, shortness of breath, difficulty swallowing, bleeding, and other symptoms.

Doctors in developed countries use modern methods of radiation therapy, which make it possible to deliver radiation very accurately, from different directions, ensuring an even distribution of the dose inside the tumor and the minimum radiation dose for healthy tissues. As a result, radiation therapy becomes not only more effective, but also safer: the risk of radiation damage to the organs surrounding the tumor is reduced.

Chemotherapy

There are two types of chemotherapy used for mesothelioma: 

• systemic;
• local. 

Systemic chemotherapy involves the administration of drugs into the patient's body, usually intravenously. These drugs enter the bloodstream, reach all parts of the body and destroy cancer cells, no matter where they are. This treatment method works at all stages, since it affects not only the primary tumor, but also metastases.

Systemic therapy may be used in the following cases: 

• before surgery to remove the tumor; 
• after surgery to reduce the risk of cancer recurrence; 
• in people with cancer that cannot be removed with surgery (often in combination with radiation therapy).

Local chemotherapy involves the administration of drugs exactly in those sites where the tumor grows. These may be peritoneal, pleural, or pericardial cavities. This treatment approach is more effective because doctors:

• increase the dose of drugs;
• solve the problem of the histohematic barrier, which prevents drugs from penetrating from the blood into the membranes affected by the tumor;
• can heat drugs that increase the effectiveness of chemotherapy.

Physicians in developed countries often use HIPEC: hyperthermic intraperitoneal chemotherapy. They rinse the abdominal cavity with a heated solution of drugs immediately after a cytoreductive operation to remove peritoneal mesothelioma.

Chemotherapy drugs can be administered both into the abdominal and chest cavities without tumor removal surgery. Their delivery requires a minor surgical procedure to place a catheter. Drugs can be administered under pressure in the form of an aerosol: they will be evenly distributed over the membrane and penetrate deeper into the tissues, more effectively suppressing tumor growth.

Immunotherapy

Immunotherapy for mesothelioma is highly effective, and therefore, this can be used as a first-line treatment method for an inoperable tumor. 

Doctors prescribe immune checkpoint inhibitors for patients with mesothelioma. These are drugs that block PD-1 or CTLA-4 molecules. They reduce the tumor's ability to evade the immune response. PD-1 and CTLA-4 inhibitors can often be used simultaneously. As a result, the immune system attacks mesothelioma more effectively. The tumor growth stops, and the size of the neoplasm can be reduced.

Targeted therapy

To treat pleural mesothelioma, doctors use drugs that block the formation of new blood vessels, VEGF (vascular endothelial growth factor) inhibitors. They are used in combination with systemic chemotherapy.

Tumors need a lot of blood to get enough nutrients. If new blood vessels are not formed, then cancer progresses more slowly. It has been proven that the inclusion of VEGF inhibitors in a drug therapy regimen increases the life expectancy for patients with an inoperable form of cancer. These drugs are administered intravenously, once every 2-3 weeks.

New treatments

So far, new treatments have not been approved as standard methods. In most countries, they are used as part of clinical trials.

Photodynamic therapy. A drug is injected into a vein that accumulates in cancer cells and makes them sensitive to light. A few days later, doctors perform an invasive procedure to irradiate the chest with a laser from the inside. The light source is placed through a short incision. Under the influence of light, a photosensitizer inside the cancer cells is activated and destroys them.

Alternating electric field therapy. A patient uses a NovoTTF-100L portable device that generates an electric field. This slows down or even stops tumor growth. The electrodes are fixed on the back and chest, and a battery is carried in a backpack for most of the day.

Gene therapy. This treatment adds new genes to cancer cells to make it easier for the immune system to destroy them. To deliver these genes, doctors use a virus, which is injected into the pleural cavity. This infects mesothelioma cells, but does not integrate into the genome of healthy cells.

Vaccine therapy. Doctors analyze several types of vaccines. In one of them, immune cells are removed from a patient's blood and processed in a laboratory to make them better respond to mesothelioma cells. They are then returned to the patient's body. Other vaccines being tested transfer certain proteins to cancer cells to stop them from growing.

You can undergo your treatment for mesothelioma abroad to get the best results. Developed countries use the latest methods, which are more effective and safer. On the Booking Health website, you can find prices and book your medical care program at the best price. Our experts will advise you on all issues and take care of the organization of your trip. When making your treatment appointment through the Booking Health service, the cost of treatment will be lower due to the lack of additional fees for foreign patients.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

NORD - National Organization for Rare Disorders

Verywell Health

Web MD