Multimodal treatment of mesothelioma
Doctors specializing in mesothelioma 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 malignant mesothelioma patients. For an over view of single-mode and multimodal treatment regimens, see the abstract of “Treatment of Malignant Mesothelioma” by M.T. Jaklitsch, S.C. Grondin, and D.J. Sugarbaker and published in the World Journal of Surgery in 2001.
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. 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.
The author concluded that “Aggressive trimodality therapy for mesothelioma is presented as a successful treatment option.” (R. Buono - “Mesothelioma Clinical Presentation”, Chest 1999; 116:444S-445S).
In recent years, there has been some progress made in the management of malignant mesothelioma, particularly in the area of combination of agents and treatment methods used. More details can be found in this interview with mesothelioma medical expert, Dr. Nicholas Vogelzang: “New Directions for the Treatment of Mesothelioma: An Expert Interview” (Oncology 6(1), 2003).
The following discussion of mesothelioma treatments is organized into separate sections (surgery, photodynamic therapy, radiation, etc.) so that each component of a combination of treatments (multimodality therapy) can be better understood.
Further Information:
“Multimodality Treatments for Mesothelioma?” by W. Eberhardt, (27th Annual congress of the European Society for Medical Oncology).
Two presentations evaluating multimodal treatment of mesothelioma were part of the program of the 37th Annual Meeting of the American Society of Clinical Oncology, May 12-15, 2001 (San Francisco). The first study, by M. Keohan, et al., used an agressive regimen for their phase II study of trimodal therapy for peritoneal mesothelioma. The second study, by J.V. Juturi, et al., investigated intracavitary paclitaxel in a multimodality management of malignant pleural mesothelioma; two earlier cooperative group studies using this treatment method yielded response rates of 0% and 9%, respectively, in patients with mesothelioma. For information about obtaining ASCO asbstracts, check their webpage.
A.M. Boylan - “Mesothelioma: new concepts in diagnosis and management” in Current Opinion in Pulmonary Medicine, March 2000; 6(2):157-163. An interesting discussion about the difficulties of diagnosing mesothelioma; the controversies about staging mesothelioma; and whether the improved survival rates of some new treatments indicate that these treatments are more effective or are explained by patient selection.
D. H. Sterman, MD, et. al. - “Advances in the Treatment of Malignant Pleural Mesothelioma” in Chest 1999; 116:504-520; (see abstract) This article discusses the roles of chemotherapy, radiotherapy, surgery and combined modality approaches in the treatment of pleural mesotheliomas. Promising new avenues may modify the therapeutic nihilism that is rampant among clinicians dealing with mesothelioma.
