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Standard Treatments

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.

Surgery

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

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

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.

Targeted Therapy

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.

Immunotherapy

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).

Targeted Therapy

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.

Immunotherapy

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).

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.