Treatment and Side Effects Management of Mesothelioma
The treatments for mesothelioma may include surgery, radiation, or drug therapies. The drug therapies are considered systemic therapies because they enter the bloodstream. They may be chemotherapies, targeted therapies, or immunotherapies.
The following procedures may be used:
Wide Local Excision - Surgery to remove cancer and some of the healthy tissue around it
- Pleurectomy and Decortication - Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs
- Extrapleural Pneumonectomy – Surgery to remove one whole lung and parts of the lining of the chest, the diaphragm, and the lining of the sac around the heart. This is the most aggressive surgery.
- Pleurodesis – Surgery to prevent fluid build-up. It uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is drained using a catheter or chest tube. The chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.
- Debulking - Surgery to remove as much of the mesothelioma as possible. In general, less tissue is removed than in a Pleurectomy/Decortication procedure.
In most cases, another form of treatment will be used before or after surgery.
Radiation Therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
Chemotherapy uses drugs to stop the growth of cancer cells. These strong drugs may harm healthy cells too, causing side effects. The most common chemotherapy for mesothelioma is either cisplatin or carboplatin given with pemetrexed (Alimta). Most often, chemotherapy is given by injection into a vein. Occasionally, drugs will be injected directly to the chest or abdomen.
These drugs treat cancer at a biological level. They fix a change a gene or protein that helps cancer grow. Doctors offer them based on the findings of lab tests. These drugs are often available in pill form and have fewer side effects. Bevacizumab (Avastin) is a drug that blocks blood vessel growth. It is sometimes used to treat pleural mesothelioma.
This type of treatment boosts the body’s immune system to fight cancer better. It is still being studied in mesothelioma. Drugs that may be used include pembrolizumab (Keytruda), ipilimumab (Yervoy), or nivolumab (Opdivo).
Tumor Treating Fields (TTF)
Tumor Treating Fields (TTF) is a new innovation for treating mesothelioma. These are electrodes placed on the torso and worn 24/7. This wearable device delivers low-frequency electric currents that can block cells from dividing. It can stop or delay cancer cells from growing. It causes few side effects, mostly skin irritation.
TTF is an FDA-approved wearable device used with chemotherapy. While no studies have been conducted to prove TTF’s effectiveness in mesothelioma, it improves survival in brain tumors. A small single arm study in mesothelioma showed safety and better than average outcomes when used with chemotherapy. It is available for newly-diagnosed mesothelioma patients whose cancer cannot be removed by surgery. It can be used for patients with locally advanced or metastatic malignant pleural mesothelioma (MPM).
Side Effects from Treatment
Different cancer treatments have different side effects. Ask about the possible side effects before you choose a treatment. Find out how to manage them. After you start treatment, write down any changes you notice. Talk to your health care team. There may be medicines or other things you can do to feel better. Keep in mind that everyone responds differently. You may not have the same side effects as someone else.
Common side effects include:
- Surgery: Side effects may include bleeding, blood clots, infection, or pain at the surgical site. Other less common side effects may occur as well.
- Radiation Therapy: Side effects may include skin changes, nausea and vomiting, diarrhea, fatigue, painful sores in the mouth and throat and dry mouth, or thick saliva. Most side effects of radiation are temporary. Some rare serious side effects can be permanent. In some cases, radiation to the chest can also cause lung damage. This may lead to problems breathing and shortness of breath.
- Chemotherapy: Side effects depend on the drug, dose, and number of treatments. They may include hair loss, mouth sores, loss of appetite, nausea, vomiting, diarrhea, changes in blood counts, infection, easy bruising or bleeding, or fatigue.
- Targeted Therapy: Side effects may include bleeding, headache, dry skin, dry or watery eyes, or a runny nose or sneezing.
- Immunotherapy: Side effects may include fatigue, diarrhea, skin rash, itching, cough, joint pain, fever, or nausea.
- Tumor Treating Fields (TTF): Side effects are minimal, mostly skin irritation.