Due to the increasing number of cases of mesothelioma, more doctors and research scientists are now searching for better treatments and, ultimately, a cure.

The Search for New Treatments

New treatments are emerging all the time. Doctors and scientists are gaining a better understanding of the design of mesothelioma. This helps researchers to develop new forms of drug treatments as well as new treatment procedures.

As these drugs or procedures are developed, they are tested in clinical trials by people who already have mesothelioma. Results of clinical trials dictate whether or not the drug or procedure will be approved in the U.S. by the Food and Drug Administration (”FDA”). Once the FDA issues an approval, the new treatment will be available to the general public.

Status of Current Research

Chemotherapy – For some time this has been the treatment of choice for mesothelioma patients, usually as a palliative measure to relieve symptoms and make the patient more comfortable. Improvements in chemotherapy vs. mesothelioma continue to bring hope to those with the disease. The most promising at this time is the drug Alimta©. This drug, when combined with another long-used chemo drug called Cisplatin, is the only Food and Drug Administration approved agent designated for specific use in combating malignant pleural mesothelioma.

Another drug that researchers currently feel is on track for imminent approval is Onconase©. Onconase is a first-in-class drug that has been shown to target cancer cells while sparing normal cells.

Anti-Angiogenesis Drugs – These drugs will, by design, prevent angiogenesis, the process by which new blood vessels are formed from pre-existing vessels. Angiogenesis plays a key role in the spreading of tumors, so researchers are searching for ways to halt the process in cancer patients. One anti-angiogenesis drug for the treatment of mesothelioma is currently available, named Avastin, and it lowers the levels of a protein that prompts angiogenesis; therefore, inhibiting cell growth.

Intensity Modulated Radiation Therapy – This new form of radiation is done in the interest of limiting the amount of radiation hitting the healthy tissue surrounding the area where the tumor is located.

Gene Therapy – Many researchers are taking a close look at gene therapy with regards to its success in treating a number of diseases, including mesothelioma. According to the American Cancer Society, this approach to treating mesothelioma uses special viruses that have been modified in the laboratory. The modified virus is injected into the pleural space and infects the mesothelioma cells. When this infection occurs, the virus injects a gene into the mesothelioma cells for interferon-beta, an immune system hormone (cytokine) that may help activate immune system cells to attack the cancerous cells.

• Put it in writing. If possible, written notes about your pain are valuable in giving accurate, comprehensive information, which you should share with your doctors and health care providers.
• Plan to ask questions. It’s important that you fully understand what your health care professional says to you about your pain. Ask questions until you are satisfied that you understand.
• Have a note-taker. Sometimes it’s difficult to talk about your pain, ask questions and take notes on what’s being said to you all at the same time, especially if you are in pain. Bringing a friend or family member to take notes during the discussion about your pain can provide a valuable resource once the conversation has ended.
• Make your views heard. Don’t hesitate to offer an opinion about what may be causing or contributing to your pain. No one knows your body as well as you, and your insights can be valuable to your health care providers.
• Medications you are taking. Tell them about your pain medications, including any over-the-counter pain relievers, any alternative medications like herbs and any medications you may be taking for other health conditions not related to cancer.
• Side effects of your pain medications. Tell them what side effects you are experiencing, how the side effects are currently being treated and if you are satisfied with this treatment.
• Quality of life issues. What impact does the pain have on your quality of life? Can you work, enjoy your family and friends, eat and sleep well? If not, describe how the pain is limiting your activities. Also, tell your health care provider(s) what you want from pain management in terms of quality of life.

These are points to consider as you prepare to discuss your pain and its management with your health care providers:

• The location of all of your pains.
• How the pain feels (use descriptive words like dull, aching, throbbing, stabbing, pinching, sharp, aching, burning, tingling).
• The intensity of your pain (when it is at its worst) and whether the intensity changes throughout the day and night.
• When you have the pain (all the time or occasionally).
• How quickly the pain comes on (suddenly or intermittently), how long it lasts (a few minutes or hours) and how often it occurs.
• What makes the pain worse? Describe conditions during which the pain becomes more intense, such as moving, walking, talking, coughing, laying down, eating, toilet time, etc.
• What eases the pain? Be ready to discuss anything that has helped you, including medication(s) you have been using and the amounts you are taking.

To keep an accurate record of what you are experiencing, consider creating a simple pain diary. You can do this in a notebook, recording information such as the date, time of day, level of pain you are feeling, what you did to remedy or alleviate it (i.e. medications taken, use of ice or heat, and so forth), and the outcome of your efforts to control the pain. (Did the medication work? For how long? Were there side effects?)

Many health care professionals also use various “pain assessment scales” to record patients’ levels of pain. You can use this system, as well, in conversation with your health care provider. Make sure you always use the SAME scale when describing your pain, for consistency and clarity. One of the simplest involves describing your pain level in terms of numbers: “0” means “no pain at all,” and “10” means “the worst possible amount of pain.” The higher the number, the greater the pain. If your health care provider uses a different assessment measuring approach, you may want to use that one. Ask for an explanation of how she or he records patient pain levels.

1. Surgery

In some cases, surgery may be indicated to give relief of symptoms or slow the progression of mesothelioma. Surgery may be performed in tandem with other treatments, such as chemotherapy and radiation. This is called multi-modal therapy.

Whether surgery is recommended will depend on factors unique to each individual situation. These factors include the type and location of the cancer, the level of development of the cancer and your overall health. Whether or not your doctor recommends surgery in your case will depend on factors individual to your case.

1a. Pleural Mesothelioma Surgeries

Thoracentesis
This procedure involves the draining of excess fluid that may have built up in the chest between the lung and the sac lining ( the pleura). This excess build up of fluid is called a pleural effusion. A tube is placed in the chest in order to drain out the excess fluid. Thoracentesis is a treatment that is meant to help relieve discomfort.

Pleurodesis
Pleurodesis is a surgical procedure to help control the excess buildup of fluid between the lungs and the lung sac lining. Pleurodesis closes the space between the lung and the lung lining, reducing the chance for fluid to accumulate.

There are two approaches to performing a pleurodesis. In the first, a tube that is inserted into the chest drains the excess fluid. After this fluid is drained, a substance that causes tissue to scar or harden, such as sterile talc powder, is injected through the chest tube and into the pleural space. This substance, called a schlerosing agent, is allowed to spread itself through the pleural space. The patient is usually asked to move about in order to facilitate the distribution of the agent. Once the agent is distributed, suction is applied to the tube in the chest. Similar to collapsing a plastic bag, the suction brings the two pleural surfaces together, allowing them to “scar” together.

The second method of pleurodesis uses thoracoscopy. In this treatment a small incision, or a series of small incisions, are made in the skin. A thoracoscope is passed through the incision in order to get a better look at the pleura. The schlerosing agent is then applied to the area.

Pleurectomy/Decortication
Pleurectomy/decortication involves removing the pleura, where most of the tumor is located. This procedure may help control pleural effusions (fluid build-up) and help to decrease the pain caused by the tumor. This is another treatment that is meant to help to lessen the discomfort caused by mesothelioma. Doctors call this type of discomfort relieving treatment a palliative treatment.

Pneumonectomy
A pneumonectomy is the removal of all or part of the lung. Your surgeon will make an incision in the side of the chest. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.

Extrapleural pneumonectomy
This extensive surgery usually involves the removal of the pleura, pericardium, diaphragm and the whole lung on the side of the cancerous tumor. Your surgeon may decide to remove some of the surrounding tissue, as well.

1b. Peritoneal Mesothelioma Surgeries

Paracentesis
Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Paracentesis (sometimes called an “ascitic tap”) can help take the pressure off the internal organs, and also helps reduce the risk of infection that may be caused by the fluid build-up. This is a palliative procedure, meaning that the goal of paracentesis is to help to relieve the discomfort associated with peritoneal mesothelioma.

Peritonectomy
A peritonectomy involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease. Your surgeon might recommend that a peritonectomy be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy where the chemotherapy drugs are administered directly into the abdomen during and/or after surgery.

Cytoreductive (or “debulking”) surgery
During cytoreductive, or debulking, surgery, the surgeon opens the abdominal cavity (a procedure known as a laparotomy) to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be long in duration due to the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area. This surgery is sometimes suggested to be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy administered into the abdominal cavity.

1c. Pericardial Mesothelioma Surgeries

Pericardiocentesis
This is the process for drawing fluid out of the affected area to help to relieve the discomfort associated with pericardial mesothelioma. For this procedure, a needle is inserted into the pericardium (the sac around the heart) to drain the fluid and relieve circulatory problems. The draining of this fluid can be associated with complications, however.

2. Chemotherapy

Chemotherapy uses chemical agents or drugs that are specifically destructive to malignant tissues and cells. Doctors may recommend single agent chemotherapy or a combination chemotherapy treatment. The single agent chemotherapy treatment involves the use one type of chemical or drug. The combination chemotherapy method involves the use of more than one chemical or drug. While it is not a cure for mesothelioma, chemotherapy treatment may slow the progression of the cancer. What follows is a partial listing of the chemotherapy treatments a doctor might recommend for treatment of mesothelioma:

• Alimta (Pemetrexed)
  Alimta, when used with Cisplatin, is indicated for treatment of malignant pleural mesothelioma and is usually given through an intravenous tube (IV infusion).
• Onconase (Ranpirnase)
  A new drug that may help slow the growth of mesothelioma tumors.
• Navelbine (Vinorelbine)
  Like Alimta, when combined with other drugs in chemotherapy, Navelbine is used to treat mesothelioma tumors. Clinical trials are still underway and testing on some patients has begun. Navelbine is usually given intravenously.
• Carbonplatin (Paraplatin)
  A chemotherapy medication that interferes with the growth of cancer cells. It has been shown to slow the spread of cancer. Some serious side effects have been reported with the use of Carboplatin.
• Cisplatin (Platinol)
  Cisplatin is a clear fluid given in combination with other drugs in the treatment of certain types of cancer, including mesothelioma. In treatment for mesothelioma, Cisplatin is usually administered with Alimta. As with many chemotherapy drugs, certain side effects may occur. Cisplatin is usually given by IV infusion.
• Related Drugs and Therapy
  Besides the chemotherapy drugs doctors prescribe for the treatment of malignant mesothelioma, there are other drugs intended for post-chemotherapy use. Doctors will also prescribe drugs intended for use while chemotherapy or radiation is underway, which are meant to minimize the side effects that can accompany these treatments.
  • Taxotere, Taxol
    Tumors can return after chemotherapy in some cases. Taxotere and Taxol are drugs that are used to help rid the body of cancer cells when cancer recurs following a previous chemotherapy treatment. These drugs inhibit the duplication or reproduction of cancerous cells. They are delivered through intravenous infusion.
  • Zofran and Anti-Nausea Drugs
    One of the most common side effects of chemotherapy treatment is nausea. Zofran is a drug used to ease nausea. Others are Emeset, Oncoden and Zofron. These drugs can help to control radiation therapy induced nausea, as well as post-op nausea and other kinds of nausea.
  • Endostatin
    A natural protein shown to inhibit the growth of blood vessels. The administration of Endostatin results in cancerous tumors “starving” due to lack of blood. This drug is still in clinical trials and has not been approved for general prescription, however.

3. Radiation Therapy

Radiation therapy is an intense X-ray treatment to damage or kill cancer cells. Although not a cure for mesothelioma, radiation therapy nonetheless may be used at different stages of the disease to slow its growth. Radiation is often the main treatment for patients in weak health. Radiation is also used to destroy small clusters of cancer cells that may have been missed in surgery. When used in conjunction with surgery, radiation treatment is referred to as adjuvant radiation.

External Beam Radiation
The form of radiation therapy used most often is external radiation, in which a machine very similar to an X-ray machine directs strong beams of light at the cancerous cells from outside the body, killing the tumor cells underneath.

Internal Radiation (Brachytherapy)
Internal radiation therapy, also called brachytherapy, involves the placement of radiation sources in the body. With mesothelioma patients, the radioactive material is positioned inside the abdomen or the chest.

4. Supportive or Palliative Therapies

Palliative treatments refer to those procedures that relieve symptoms and help make the patient more comfortable. Here are some palliative therapies that may be used to treat mesothelioma:

Pleurodesis
Pleurodesis is a procedure that is sometimes used to control pleural effusion, or the build up of fluids between the lungs and the lung lining. Pleurodesis causes the space between the lungs and the lung lining to close, reducing the chance for fluid to accumulate. One method of pleurodesis uses thoracoscopy, whereby a small incision, or a few small incisions are made in the skin and a thoracoscope is passed through the incision to get a better look at the pleura. The sclerosing agent is then applied.

Pain Management
Pain management is another way to treat the discomfort associated with mesothelioma.