Not long ago, doctors and patients considered a mesothelioma diagnosis to be a death sentence. Luckily, we’ve come a long way since then — and the treatments are only getting better. Experts are still searching for a cure, but they’re making progress every day.
Standard treatment options like surgery, chemotherapy and radiation therapy have been proven to extend survival and improve quality of life, giving patients more time with their family and loved ones. Some therapies aim to cure the cancer, while others treat symptoms to make life easier.
Many patients who were disheartened by the cancer’s average life expectancy of one year have beaten the odds, providing hope to the entire mesothelioma community. Three- to five-year survival is becoming more common, and there are even extraordinary cases of patients who have extended their survival beyond a decade.
Treatments with the Highest Success Rates
Once your doctor confirms a mesothelioma diagnosis, a team of specialists will build a treatment plan that offers the best chance of improving your prognosis and quality of life. Currently, the most effective and reliable treatments include surgery, chemotherapy and radiation therapy. You may even qualify for experimental therapies offered in clinical trials.
Perhaps one of the best ways to improve your survival is to undergo surgery that attempts to remove as much tumor growth as possible. For pleural mesothelioma patients who qualify, doctors typically offer an extrapleural pneumonectomy (EPP) or a pleurectomy/decortication (P/D).
Peritoneal mesothelioma patients can benefit from cytoreductive surgery, which aims to remove tumors that have spread within the abdomen. Research suggests that complete or near-complete removal of the cancer offers the best chance of survival. In many cases, doctors will offer additional treatments before or after surgery to improve results and prevent the cancer from returning.
Not every patient is a good candidate for surgery. The cancer may be too far advanced to remove completely, or a history of heart disease or other health issues could make the procedure too risky. No matter what your situation is, there is a wide range of treatment options that can extend your survival and improve your well-being.
For decades, cancer patients have relied on chemotherapy, a treatment option that uses one or more drugs to shrink tumors and slow down the growth and progression of cancer.
At first, doctors administered a single chemotherapy drug through an intravenous (IV) line into a mesothelioma patient’s arm or sometimes gave the drugs in pill form. While these methods are still widely used today, specialists have seen promising results with newer and more experimental approaches to chemotherapy.
Some treatment centers now deliver heated chemotherapy directly to the area where the cancer formed, a technique that has added years to the lives of select peritoneal patients. Today, the standard front-line treatment for unresectable mesothelioma is a combination of two drugs, permetrexed and cisplatin. This is based on a 2003 phase 3 clinical trial which demonstrated that pleural mesothelioma patients treated with both drugs had significantly longer survival than those treated with just one. Patients who received folic acid and Vitamin B12 during this two-drug treatment experienced even longer survival, as well as reduced chemotherapy side effects.
In 2016, another phase 3 trial found that the addition of a third drug, bevacizumab, further improved survival in unresectable mesothelioma patients. This three-drug combination is currently the standard of care in France. It is considered an option for front-line treatment in the United States, although insurance companies have been slow to cover it.
Radiation therapy is another standard cancer treatment. While doctors rarely offer the technique to peritoneal mesothelioma patients, they often recommend it to pleural patients after surgery. It can be difficult to treat mesothelioma with radiation because the cancer usually develops into many small tumors, not a single growth that doctors can easily target.
During the procedure, a radiologist blasts cancerous areas with X-rays or other high-energy particles, destroying cancer cells or stopping them from dividing. There are two main types of radiation therapy doctors use to treat mesothelioma:
- External beam radiation therapy (EBRT)
Most mesothelioma specialists perform radiation therapy with EBRT, a technique that uses a machine outside the patient’s body to produce cancer-killing X-rays.
Unlike EBRT, brachytherapy delivers radiation through a wire or capsule that doctors implant within or near the tumor. While it’s not a standard mesothelioma therapy, researchers are actively studying brachytherapy in clinical trials.
Combining two or more treatments
To extend survival and attempt to prevent recurrence, mesothelioma experts have adopted a multimodal approach to treatment — one that combines two or more therapies in a patient’s course of treatment.
Surgery, chemotherapy and radiation therapy are the three most common modalities (treatment options) used. When combined, these treatments can extend survival longer than any single option given on its own.
Although there is still no universally accepted treatment plan for mesothelioma, many studies have shown multimodal therapy offers the best chance of long-term survival.
One of the most popular multimodal treatment plans for pleural mesothelioma is EPP surgery with chemotherapy and radiation therapy. Follow-up from patients who underwent this treatment showed a median overall survival of 14 to 28 months.
For peritoneal mesothelioma patients who qualify, one of the most promising life-extending treatment plans involves cytoreductive surgery followed by heated intraperitoneal chemotherapy (HIPEC).
Despite mesothelioma’s notoriously poor survival outlook, there are long-term survivors.
After being diagnosed with mesothelioma in 2013, Army veteran Billy K. vowed to beat the cancer. Despite the uncertainty of his doctors, he remained determined. Billy underwent three rounds of chemotherapy, but decided to embrace alternative therapy with moringa extract over surgery and radiation. His last CT scan showed no signs of cancer, and Billy says moringa helped bring his cancer into remission.
When Trina was diagnosed with peritoneal mesothelioma in 2001, her doctor told her she only had a year to live. Hoping to improve her prognosis, Trina underwent multimodal therapy with cytoreductive surgery, HIPEC and radiation therapy. Although recovery was challenging, her treatment was successful. Trina is now a mesothelioma survivor of more than 10 years.
In 2002, Tim C. developed pleural mesothelioma. After learning about the disease’s grim prognosis, Tim thought it would be pointless to put himself through radical treatments like surgery and chemotherapy. It took a powerful letter from his daughter to change his mind. Soon after, he traveled to Boston for an EPP, which gave him another 10-plus years with his family.
The Debate: EPP vs. P/D
If you are a pleural mesothelioma patient who qualifies for surgery, your doctor will suggest either EPP or P/D. Both are widely used to treat the cancer, but doctors are still debating which procedure offers the greatest survival benefit. Currently, doctors evaluate each case individually and select a surgery that offers the best chance for long-term survival. Surgeons consider the patient’s current stage of disease and overall health, as well as any plans for multimodal therapy.
- EPP - Extrapleural Pneumonectomy
This surgery removes an entire lung, diaphragm and parts of the lining surrounding the chest and heart. It’s performed on patients whose cancer hasn’t spread to the lymph nodes or surrounding organs.
For decades, doctors considered EPP the best option for potentially curative surgery. However, the aggressive surgery is associated with high rates of death and complications, and many patients aren’t healthy enough to qualify.
- P/D - Pleurectomy/Decortication
P/D spares more of the healthy lung tissue and has significantly lower death rates, but does not allow doctors to remove as much cancerous tissue as an EPP.
A 2008 multicenter study comparing the outcomes of more than 600 patients treated with EPP and P/D found that patients treated with P/D had better survival outcomes. While the results of this study prompted a sharp decline in the number of EPP procedures performed and boosted the popularity of P/D, the results were not conclusive enough to end the debate.
The Difference Between Palliative and Curative Treatments
Not all treatment options aim to cure the cancer. Your doctor may also recommend one or more palliative treatments that focus only on alleviating pain or other symptoms that reduce your quality of life. Oncologists most commonly offer palliative treatments to late-stage patients who would not benefit from the standard curative therapies.
Surgery, chemotherapy and radiation therapy can all be offered as either curative or palliative treatments. Before you start treatment, speak with your doctor and make sure you understand the goal of each treatment they recommend.
Pleural mesothelioma patients often benefit from thoracentesis and pleurodesis. These palliative procedures address the pain and breathing difficulty caused by pleural effusion, a common mesothelioma symptom where excess fluid builds up in the chest. Thoracentesis removes the extra fluid between the lungs and their protective lining (the pleura), while pleurodesis removes the fluid and closes the space between the pleura and lungs so no more fluid can accumulate.
Fluid buildup is also a problem for peritoneal mesothelioma patients. A procedure called paracentesis allows doctors to remove excess fluid from the abdomen, which can help with pain and breathing issues. Doctors can also help patients feel better by shrinking tumors with palliative chemotherapy and radiation therapy.
Emerging Mesothelioma Treatments
Because mesothelioma lacks a definitive cure and is likely to return after treatment, researchers are always striving to discover newer and better therapies.
One emerging treatment called immunotherapy empowers a patient’s immune system to fight the cancer on its own. Early studies on immunotherapy drugs show great potential, and patients are already seeing promising results.
Andy A., a four-year pleural mesothelioma survivor who was ineligible for surgery, joined a clinical trial for the immunotherapy drug amatuximab. He started combined treatment with standard chemotherapy drugs and amatuximab, but eventually switched to immunotherapy alone. The experimental treatment halted the growth of Andy’s tumors and helped him surpass his initial prognosis of one to two years.
Clinical trials are also investigating gene therapy, which uses genes (hereditary molecules like DNA and RNA) to treat mesothelioma. Because cancer is a disease caused by problems with genes, researchers are exploring various ways to manipulate these molecules to improve patient outcomes.
During gene therapy, doctors may use a modified virus to repair or replace defective genes. Another approach introduces proteins called cytokines that can boost a patient’s immune system to attack the cancer, much like immunotherapy.
Suicide Gene Therapy
Suicide gene therapy, which causes cancer cells to self-destruct, seems to be the most promising gene therapy for mesothelioma. In clinical trials conducted at the University of Pennsylvania Medical Center, suicide gene therapy reduced the size and severity of tumors in four of the 34 mesothelioma patients studied.
The best way to gain access to these and other cutting-edge mesothelioma treatments is to participate in a clinical trial. These studies test the safety of new treatments and help doctors learn how to deliver them most effectively.
Promising Clinical Trials
Researchers perform clinical trials to test new ways to approach surgery, chemotherapy and radiation therapy, or explore new treatment options that could one day become the standard of care. They also seek out better ways to detect the cancer early.
Mesothelioma doctors recommend clinical trials to most stage IV patients, but there are trials for patients in every stage of cancer development.
The U.S. National Institutes of Health lists all mesothelioma clinical trials on its website. Your doctor can also help you find a clinical trial for which you qualify. Some of the latest clinical trials open to mesothelioma patients include:
- Tremelimumab - The Anti-CTLA-4 Monoclonal Antibody
This trial will test the effectiveness of a new targeted therapy for pleural mesothelioma patients who don’t qualify for surgery.
- Intrapleural HSV1716 - Treat Patients with Malignant Pleural Mesothelioma
This trial will determine the safety of treating mesothelioma with a specially modified virus doctors deliver directly to the pleura.
- High Risk Genes? - Examines DNA from Blood Samples
This trial will help doctors learn more about how genetics affect a person’s risk for developing mesothelioma.
- SS1P and Pentostatin - Plus Cyclophosphamide for Mesothelioma
This trial will test an experimental targeted therapy called SS1P alongside two other drugs that are expected to improve the treatment’s effectiveness.
Survivor Experiences with Alternative Treatments
Ruth P. refused to accept the eight-month prognosis several leading cancer centers gave her in 1999 for peritoneal mesothelioma. Instead of traditional therapy, she traveled to the Bahamas for alternative treatment at the Immune Augmentative Therapy Centre (IAT). She received daily injections IAT claimed would help her immune system control the growth of tumors. She has already passed the 14-year mark.
Wayne N. was diagnosed with peritoneal mesothelioma in 1991, and attributes his long-term survival to alternative treatment. He boosted his immune system using only diet and exercise, instead of chemotherapy and radiation. His secret: Antioxidant-rich red tart cherries — one of several fruits researchers are studying for their anti-cancer effects. He has lived 20 beyond his prognosis.
Pleural mesothelioma survivor Rich D. was diagnosed with the cancer in 2012. He advocates graviola tea leaves, another natural treatment. After his pleurectomy/decortication surgery, Rich declined chemotherapy and radiation therapy. He says the graviola tea and his faith have helped keep the cancer at bay for nearly two years. “God gave me a second chance here, so I’m going to make the most of it.”