Multimodal Therapy for Mesothelioma

Quick Summary

There are several approaches to multimodal therapy for patients, from clinical trials to traditional approaches and everything in between. Treatment orders and options are best decided on by specialists based on patient health, the stage of cancer and other important factors.

Multimodal Therapy Overview

Multimodal therapy involves the use of several treatments to decrease the mesothelioma cancer cells, stop the spread of these cells or improve life expectancy for patients. While there are several factors involved in deciding on the order of treatment, talking with your specialist about treatment options or clinical trials is the best way to determine the right approach for you.

What Is Multimodal Therapy?

Multimodal therapy focuses on removing cancerous tumors with several treatments for premium results. Multimodal therapy is tailored to each patient’s unique case.

The most-used multimodal therapy approaches are radiation and chemotherapy that is administered before, during, and/or after surgery.

While multimodal approaches and treatments can be highly effective, they are not always the best option depending on the stage of cancer or a patient’s health or medical history. Consulting with a specialist about the benefits and side effects of therapy can help determine if multimodal therapy is the best option.

Mesothelioma Multimodal Approaches

There are 2 main approaches to multimodal therapy for mesothelioma patients:

Adjuvant (after) and neoadjuvant (before) therapy are similar but vary based on the order of use during treatment.

Adjuvant Therapy

Used primarily after surgery, adjuvant therapy is considered additional treatment to minimize the risk of the cancer returning. While surgery removes as much of visible cancer cells as possible, microscopic bits may remain undetected and additional treatments may stop any returning cell growth.

Treatment options for adjuvant therapy may include:

  • Chemotherapy: Anti-cancer drugs that enter the entire body into the bloodstream to kill cancer orally or by vein.
  • Radiation Therapy: High-powered energy beams (like X-rays) that enter the body internally or externally to kill cancer cells. Adjuvant radiation therapy targets the area around the original cancer location to reduce the risk of recurrent growth.
  • Immunotherapy: A method of working with the body’s immune system to fight off remaining cancer cells by stimulating or supplementing the body’s defenses.
  • Targeted Therapy: Used to alter specific abnormalities in certain cancer cells to target the unique features and use targeted therapy drugs to work on eliminating those cells.
  • Hormone Therapy: Analysis of cancerous cells sometimes reveals a sensitivity to hormones. Treatments to stop the hormone production or block the effect of the hormone may be beneficial.

Adjuvant therapy is not beneficial to all patients, and potential side effects of these treatments can be severe for some patients. Please consult with your doctor about these factors when discussing treatment options.

Neoadjuvant Therapy

Adjuvant therapy used before the main treatment of mesothelioma is called neoadjuvant therapy and is used primarily to make radiation or surgery more effective and easier. Given as a first step in treatment, usually before surgery, this works to shrink tumors as a form of initial care (induction therapy).

Treatment options for neoadjuvant therapy may include:

  • Chemotherapy: Anti-cancer drugs that enter the entire body through the bloodstream to kill cancer orally or by vein.
  • Radiation Therapy: High-powered energy beams (like X-rays) that enter the body internally or externally to kill cancer cells. Adjuvant radiation therapy targets the area around the original cancer location to reduce the risk of recurrent growth.
  • Hormone Therapy: Analysis of cancerous cells sometimes reveals a sensitivity to hormones. Treatments to stop the hormone production or block the effect of the hormone may be beneficial.

Neoadjuvant therapy is not beneficial to all patients, and the potential side effects of these treatments can be severe for some patients, so please consult with your doctor about these factors when discussing treatment options.

Types of Multimodal Therapy

There are different types of multimodal therapy combinations proven to most effectively treat forms of mesothelioma. Many multimodal therapies started out as unconventional approaches but are now being recognized for their innovativeness in targeting and treating mesothelioma.

SMART

SMART is the approach of using multimodal treatments to influence the life expectancy of mesothelioma patients, but using a method that switches around the order of treatments to improve results.

SMART is a 2-step process that involves:

  • Intensity Modulated Radiation Therapy (IMRT): Patients are given a high dose of IMRT, which administers simultaneous levels of radiation through the area. Radiation levels are higher than normal treatments and are made possible only because the irradiated lung is removed shortly after treatment (EPP).
  • Extrapleural Pneumonectomy (EPP): Approximately 6 days after a patient is given IMRT the affected lung and surrounding tissue is removed. Further studies are being conducted to try to save the lung for patients in the future.

The success of SMART is largely due to confining cancer to the lung and the tumor, while the other mesothelioma cells are killed throughout the chest cavity. Being able to provide higher doses of radiation then removing the lung, has increased results because the chances of the radiation or cancerous cells moving through the body are deliberately limited.

Another factor is that giving radiation before surgery is easier for patients to recover from than giving radiation before surgery.

Intraoperative Chemotherapy and Radiation

Delivering irradiation (intraoperative radiation) or chemotherapy (intraoperative chemotherapy) drugs during surgery is often used to improve control of the location of the tumor during operations. Frequently, this dose of radiation or chemotherapy is limited by the presence of healthy tissue in the same area.

Multimodal Therapy Survival Rates

Survival rates are used as an approximation of life expectancy for patients with similar diagnosis survived.

These statistics vary based on a range of factors that include:

  • Age
  • Gender
  • Stage of the cancer
  • Cell type and histology
  • Treatment options

Survival rates for many patients can differ from the initial prognosis due to several factors or misinterpretation. Sometimes they vary regardless of treatment or because of the method of treatment. As people are unique, survival rates can also be unique and should only be used as a guideline.

Speak to your doctor about survival rate statistics and concerns you may have, as these vary due to the factors listed above and any potential breakthroughs in current studies.

Multimodal Therapy With New Treatments

Clinical trials are a large source of development for new treatments and procedures for patients that do not have the option of traditional therapies or treatments. If the cancer is too advanced, a clinical trial in combination with other treatments may be the best chance to extend life expectancy or improve quality of life.

Speak to your doctors about current clinical trials or multimodal therapies in combination with new treatments available in clinical trials to learn if this option is the best approach for you.

For more information on working with a mesothelioma specialist near you, contact our Patient Advocates today.

View Author and Sources
Author

Sources
  1. Mayo Clinic, “Adjuvant Therapy: Treatment to Keep Cancer From Returning.” Retrieved from: https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/adjuvant-therapy/art-20046687 Accessed January 31, 2018.
  2. National Cancer Institute, “Definiteion of Neoadjuvant Therapy.” Retrieved from: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45800 Accessed January 31, 2018.
  3. Science Direct, “Intraoperative Radiation Therapy.” Retrieved from: https://www.sciencedirect.com/science?_ob=PdfExcerptURL&_imagekey=3-s2.0-B9781416058977000172-main.pdf&_piikey=B9781416058977000172&_cdi=281934&_orig=article&_zone=centerpane&_fmt=abst&_eid=3-s2.0-B9781416058977000172&_user=12975512&md5=c1e392a6b581db20e03fb8dfbf9d4eb6&ie=/excerpt.pdf Accessed February 1, 2018.

  4. Mesothelioma Guide, “Mesothelioma SMART Treatment.” Retrieved from: https://www.mesotheliomaguide.com/treatment/cure/smart/ Accessed February 1, 2018.
  5. Mesothelioma Guide, “Improving Mesothelioma Survival Rate.” Retrieved from: https://www.mesotheliomaguide.com/prognosis/survival-rate/ Accessed February 1, 2018.

Last modified: October 24, 2018