Malignant Mesothelioma: Treatment Choices

There are many treatment choices for malignant mesothelioma. The one that's best for you depends on things like:

• The type of cancer

• The size of the cancer and where it is in your body

• The stage (extent) of the cancer

• Whether all of the cancer can be removed with surgery (is resectable)

• Your general health

• What side effects you’re OK with

• Your personal concerns and preferences, like what type of treatment you're OK with

Mesothelioma can be hard to treat. It's best to have a team of experts who have treated a lot of people with this type of cancer.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel, how your body will work after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can explain what your treatment choices are, the goals of treatment, how well treatment is expected to work, and what the risks and side effects may be.

Your healthcare provider may advise a certain treatment. Or they may offer more than one and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best choice.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get a second opinion before deciding on your treatment plan. You may also want to include your partner, spouse, family, or friends in this process.

Goals of treatment for mesothelioma

For some people with mesothelioma, the goal of treatment is to cure the cancer. If a cure isn’t possible, treatment can be used to shrink the cancer or help keep it under control. Treatment can also improve your quality of life by helping to control symptoms caused by the disease. The goals of treatment can include one or more of these things:

• Remove or destroy the mesothelioma in the place where it started while doing as little damage as possible to nearby areas

• Kill the cancer cells or keep them from growing or spreading

• Help prevent or delay the cancer's return

• Ease symptoms caused by the cancer, such as pain, trouble breathing, or swallowing problems

Types of treatment for mesothelioma

Treatment for cancer is either local or systemic. You may have both.

• Local treatments remove, destroy, or control cancer cells in a certain place in the body. Surgery and radiation are local treatments.

• Systemic treatments destroy or control cancer cells throughout the body. Chemotherapy and targeted therapy are examples.

Commonly used treatments for mesothelioma

Here’s a list of common mesothelioma treatments:

Surgery

For some early-stage mesotheliomas (those that are small and haven't spread), surgery can be used to try to remove all of the cancer. This is often a complex operation. And it can be very hard to take out all of the mesothelioma.

In some cases, surgery is done to remove as much of the cancer as possible. Then other treatments are used to kill any cancer cells that were left behind.

For more advanced cancers, less complex surgery may be used to help ease symptoms, like trouble breathing or fluid buildup.

Radiation

Radiation therapy uses high-energy X-rays or beams of particles to kill cancer cells. This treatment might be used after surgery. It’s done to try to kill any remaining cancer cells and lower the chance that the cancer will come back.

It may also be used to help relieve symptoms. For instance, it can be used to shrink tumors that are making it hard to breathe or swallow.

Chemotherapy

Chemotherapy (chemo) is the use of strong medicines to kill cancer cells. For mesothelioma that hasn't spread beyond where it first started, chemo might be used before surgery. This is done to try to shrink the tumor and make it easier to remove. Sometimes it's given after surgery to try to kill any remaining cancer cells.

Chemo is often the main treatment (sometimes along with radiation therapy) for people with mesothelioma who can't have surgery.

Some chemo medicines that may be given are pemetrexed and cisplatin or carboplatin.

Targeted therapy

This treatment uses medicines that target certain parts of cancer cells. For instance, mesothelioma cells use a growth factor (called VEGF) to make the new blood vessels they need to grow. A medicine called bevacizumab keeps VEGF from working, so the cancer cell growth slows or stops. It may be given along with chemo to help people with mesothelioma live longer.

Immunotherapy

These medicines help your immune system find and kill cancer cells. Some mesothelioma cells use certain proteins to keep your immune system from attacking them. Medicines that block these proteins can boost the immune system against these cancer cells.

Immunotherapy might be used as the first treatment if the mesothelioma can't be removed with surgery. It might also be used if chemo stops working. Examples of immunotherapy medicines used to treat mesothelioma include ipilimumab and nivolumab. These medicines are a type of immunotherapy called monoclonal antibodies and are also a type of immune checkpoint inhibitor.

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms but don’t treat the cancer. These are often used along with other treatments that do treat the cancer. Some examples are medicine to control nausea and radiation therapy to shrink a tumor that's causing breathing problems.

Your healthcare provider may suggest using only supportive care if they believe that treatment is likely to do you more harm than good. It can help you feel better.

Clinical trials for new treatments

Researchers are always looking for new ways to treat mesothelioma. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. Before starting treatment, talk with your healthcare provider to find out if there are any clinical trials you should think about.

Most experts agree that treatment in a clinical trial should be considered for any type or stage of mesothelioma.

Talking with your healthcare provider

At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and side effects of each option. Discuss your concerns with your healthcare provider before making a decision.