Treatment of malignant mesothelioma
Malignant mesotheliomaMalignant mesothelioma is a rare type of cancer in which malignant cells are found in the sac lining the chest or abdomen. Exposure to airborne asbestos particles increases one's risk of developing malignant mesothelioma. The cancer typically develops 20 to 40 years after a person's initial...
using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved on average 74.6 percent successful in extending the patient's life span by five years or more [commonly known as remission][this percentage may increase or decrease depending on date of discovery / stage of malignant development] (Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself which has proved only be 16.3 percent likely to extend a patient's life span by five years or more [commonly known as remission]. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
Surgery
Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm
Thoracic diaphragm
In the anatomy of mammals, the thoracic diaphragm is a sheet of muscle extending across the bottom of the rib cage. The diaphragm separates the thoracic cavity from the abdominal cavity and performs an important function in respiration...
and the pericardium
Pericardium
The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:There are two layers to the pericardial sac: the fibrous pericardium and the serous pericardium...
are removed.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy
Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin
Cisplatin
Cisplatin, cisplatinum, or cis-diamminedichloroplatinum is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas , lymphomas, and germ cell tumors. It was the first member of a class of anti-cancer drugs which now also includes carboplatin...
chemotherapy alone with a combination of cisplatin and pemetrexed
Pemetrexed
Pemetrexed is a chemotherapy drug manufactured and marketed by Eli Lilly and Company. Its indications are the treatment of pleural mesothelioma as well as non-small cell lung cancer.-History:...
(brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median
Median
In probability theory and statistics, a median is described as the number separating the higher half of a sample, a population, or a probability distribution, from the lower half. The median of a finite list of numbers can be found by arranging all the observations from lowest value to highest...
survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis
Stomatitis
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth...
, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and political science. Quality of life should not be confused with the concept of...
and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is a Government agency of the United States Department of Health and Human Services and is responsible for regulating and supervising the safety of foods, tobacco products, dietary supplements, Medication drugs, vaccines, Biopharmaceutical, blood transfusion,...
approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed
Raltitrexed
Raltitrexed is an antimetabolite drug used in cancer chemotherapy. It is an inhibitor of thymidylate synthase, and is manufactured by AstraZeneca.-Mechanism of action:...
has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin
Bacillus Calmette-Guérin
Bacillus Calmette-Guérin is a vaccine against tuberculosis that is prepared from a strain of the attenuated live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans by being specially cultured in an artificial medium for years...
(BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer
Bladder cancer
Bladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
Notable people who died from mesothelioma
Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan
Hamilton Jordan
William Hamilton McWhorter Jordan was Chief of Staff to President of the United States Jimmy Carter.-Early life:...
, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear
Bob Bellear
Bob Bellear was the first Indigenous Australian judge.Bob was born in the far north-east of New South Wales, and grew up near the town of Mullumbimby...
died in 2005. British science fiction writer Michael G. Coney
Michael G. Coney
Michael Greatrex Coney was a British science fiction writer who spent his last years in Canada. Born in Birmingham, England on September 28, 1932, he moved to Victoria, British Columbia in 1972...
, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason
Paul Gleason
Paul Xavier Gleason was an American film and television actor.-Early life:Gleason was born in Jersey City, New Jersey, the son of Eleanor , a registered nurse, and George L. Gleason, a restaurateur, professional boxer, iron worker, and roofing manufacturer. Gleason was raised in Uleta, however the...
, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club
The Breakfast Club
The Breakfast Club is a 1985 American teen film written and directed by John Hughes. The storyline follows five teenagers as they spend a Saturday in detention together and come to realize that they are all deeper than their respective stereotypes...
, died in 2006. Mickie Most
Mickie Most
Mickie Most, born Michael Peter Hayes , was a successful English record producer, with a string of Number One singles with his own RAK Records, and with acts such as The Animals, Herman's Hermits, Donovan, and Suzi Quatro and the Jeff Beck Group.-Early career:Most was born in Aldershot, Hampshire...
, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.
Bernie Banton
Bernie Banton
Bernard Douglas Banton AM was an Australian social justice campaigner. He was the widely-recognised face of the legal and political campaign to achieve compensation for the many sufferers of asbestos-related conditions, which they contracted after working for the company James Hardie.Banton...
was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie
James Hardie
James Hardie Industries Ltd. is an industrial building materials company headquartered in the Netherlands and listed on the Australian Securities Exchange which specialises in fibre cement products. James Hardie manufactures and develops technologies, materials and processes for the production of...
after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister Kevin Rudd
Kevin Rudd
Kevin Michael Rudd is the 26th and current Prime Minister of Australia and federal leader of the centre-left Australian Labor Party . Under Rudd's leadership, the Labor Party won the 2007 federal election on 24 November against the incumbent centre-right Liberal/National coalition government led...
mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian federal election.
Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits. (It is also reported that he worked in a shipyard
Shipyard
Shipyards and dockyards are places which repair and build ships. These can be yachts, military vessels, cruise liners or other cargo or passenger ships. Dockyards are sometimes more associated with maintenance and basing activities than shipyards, which are sometimes associated more with initial...
during World War II, where he might have been exposed to asbestos. )
United States Congressman Bruce Vento
Bruce Vento
Bruce Frank Vento , American politician, was a Democratic-Farmer-Labor member of the United States House of Representatives from 1977 until his death in 2000, in the 95th, 96th, 97th, 98th, 99th, 100th, 101st, 102nd, 103rd, 104th, 105th, and 106th congresses, representing .Vento was born in Saint...
died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF
Mesothelioma Applied Research Foundation
The Mesothelioma Applied Research Foundation is a non-profit organization that funds mesothelioma research, provides services to patients, educates the public, and advocates in Washington, DC for governmental funding for mesothelioma research...
Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon
Warren Zevon
Zevon redirects here. For his son Jordan, see Jordan ZevonWarren William Zevon was an American rock singer-songwriter and musician noted for including his strange, sardonic opinions of life in his musical lyrics, composing songs that were sometimes humorous and often had political or historical...
was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind
The Wind (album)
The Wind is the last studio album by American singer/songwriter Warren Zevon, released in 2003. Zevon began recording the album shortly after he was diagnosed with inoperable mesothelioma, and it was released just two weeks before his death on September 7 2003 .The album was awarded the Grammy...
including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
Christie Hennessy
Christie Hennessy
Christie Hennessy was an Irish folk singer-songwriter.- Early life :...
, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death. His mesothelioma has been attributed to his younger years spent working on building sites in London
London
[]London is the capital of England and the United Kingdom. It has been a major settlement for two millennia, and the history of London goes back to its founding by the Romans, when it was named Londinium. London's core, the ancient City of London, the 'square mile', retains its medieval boundaries...
.
Bob Miner
Bob Miner
Bob Miner co-founded Software Development Labs in August 1977 with Larry Ellison, and Ed Oates. Software Development Labs later became Oracle Corporation.If Larry Ellison was the brain behind Oracle, Bob Miner was its heart...
, one of the founders of Software Development Labs, the forerunner of Oracle Corporation
Oracle Corporation
Oracle Corporation specializes in developing and marketing enterprise software products — particularly database management systems. Through organic growth and a number of high-profile acquisitions, Oracle enlarged its share of the software market...
died of mesothelioma in 1994.
Scottish Labour MP John William MacDougall died of mesothelioma on August 13, 2008, after fighting the disease for two years.
Canberra
Canberra
Canberra is the capital city of Australia. With a population of over 345,000, it is Australia's largest inland city and the eighth largest Australian city overall. The city is located at the northern end of the Australian Capital Territory, south-west of Sydney, and north-east of Melbourne...
journalist and news presenter, Peter Leonard
Peter Leonard
Peter Antony Leonard was an Australian journalist and newsreader. He was born in Yass, New South Wales, the son of a Greek immigrant father who died when Peter was 17. He was educated at Yass Primary School then at Canberra Grammar School as a boarder...
also succumbed to the condition on 23 September 2008.
Terrence McCann
Terrence McCann
Terrence John McCann was an American wrestler who won the Gold Medal in the bantamweight division of freestyle wrestling at the 1960 Summer Olympics in Rome, and later helped found the United States Wrestling Federation...
Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006 at his home in Dana Point, California.