| Mesothelioma treatment options depend on many | | | | gene is called p53. If this gene is damaged or non |
| internal factors such as: stage, location, and the | | | | existent oncogenes or cancer genes multiply at an |
| patient's age and desires. Important external factors | | | | abnormal rate. The main focus of gene therapy for |
| to consider include the experience level of the | | | | mesothelioma involves injecting a virus that has been |
| oncologist with mesothelioma cases and whether or | | | | modified in the laboratory. The virus is injected into |
| not a rural dweller would have to be transferred to a | | | | the pleural space in the chest, where mesothelioma |
| larger city for aggressive treatment or palliative care. | | | | develops as an attempt to kill the cancer cells. |
| Patient survival rate is determined to be up to a | | | | Drug or Vaccine Therapy |
| year; while some leading cancer centers have | | | | Patients with mesothelioma have much higher levels |
| reported life expectancy after diagnosis to be as | | | | of vascular endothelial growth factor (VEGF) a |
| much as five more years. | | | | chemical controlling blood vessel than people with any |
| Screening | | | | other type of cancer. Trials are being conducted to |
| Imaging tests allow doctors to see a picture of the | | | | see if VEGF can be blocked, thus stopping the |
| cancer site. These tests could include x-rays, CT | | | | growth of blood vessels feeding the mesothelioma |
| scans (computed tomography), or MRI (magnetic | | | | tumors. |
| resonance imaging). | | | | Bevacizumab is a drug vaccine currently in use. One |
| New Screening Instrument: The Mesomark Test | | | | trial recently reported that this drug may increase |
| The Food and Drug administration has just approved | | | | survival for patients with lung cancer. An American |
| (January 2007) the world's first in-vitro test for | | | | phase 2 trial tested bevacizumab for mesothelioma, in |
| mesothelioma. The Mesomark assay test, developed | | | | combination with chemotherapy drugs. Bevacizumab |
| by Fujirebio Diagnostics is administered to patients | | | | is still in the experimental phase and much larger trials |
| diagnosed with biphasic or epithelioid mesothelioma by | | | | are needed before we will know how effective it will |
| a simple blood test. The test measures proteins | | | | be in treating mesothelioma and other types of |
| within the blood that reflect changes in the patient's | | | | cancers. |
| tumor volume, a key factor for monitoring patient | | | | Photodynamic Therapy (PDT) |
| status and response to therapies. | | | | In Photodynamic therapy a drug called a |
| Traditional Treatment Types | | | | photosensitizing agent is injected into the |
| Surgery, removal of the entire lung and a part of the | | | | bloodstream and absorbed by the body's cells |
| chest lining, the diaphragm and part of the sac | | | | rendering the cells sensitive to light. When the area to |
| surrounding the heart. | | | | be treated is exposed to laser light, the cells are |
| Thoracoscopy is the insertion of an endoscope which | | | | killed. PDT has to be combined with surgery to treat |
| is a small narrow tube, containing a tiny cameria into | | | | patients in the early stages of mesothelioma. PDT is |
| the pleural cavity to look directly at the tumor. | | | | still in the trial stages and very experimental. |
| Pathologist's perform a biopsy to collect a tissue. | | | | Clinical Trials and Eligibility |
| Often, chemical pleurodesis (draining fluid in the | | | | Clinical Trials provide research by using a sampling of |
| intrapleural space), can be accomplished during the | | | | people affected by the cancer. The National Cancer |
| same procedure. | | | | Institute states that the purpose of most listed |
| Mediastinoscopy, another type of surgical incision is | | | | clinical trials is to test new cancer treatments or new |
| sometimes used to stage the extent of disease | | | | methods of diagnosing, screening for or preventing |
| when enlarged nodes are seen using imaging | | | | cancer. |
| techniques. | | | | Eligibility requirements for clinical trials are not the |
| Laproscopy is used in mesothelioma patients when | | | | same; each study has specific guidelines for |
| imaging techniques suggest that the tumor has | | | | participation. Some trials allow participation after other |
| penetrated through the diaphragm. This information is | | | | treatments have failed, while others require that the |
| important in evaluating a patient for potential | | | | patient did not have prior treatment. Choosing a |
| pleurectomy or extrapleural pneumonectomy. | | | | clinical test should only be done after a medical |
| Radiation Therapy (using high-dose x-rays or other | | | | consultation. |
| high-energy rays to kill cancer cells. | | | | Prevention trials - study ways to reduce the risk, or |
| Radiation - Although mesothelioma tumors are highly | | | | chance, of developing cancer. Most prevention trials |
| resistant to radiotherapy, these treatments are | | | | are conducted with healthy people who have not had |
| sometimes used to relieve symptoms arising from | | | | cancer. These trials use drugs, vitamins or diet to |
| tumor growth, such as obstruction of a major blood | | | | reduce risk of cancer. Some trials are conducted with |
| vessel. | | | | people who have had cancer and want to prevent |
| Radiotherapy is commonly applied to the sites of | | | | the return of cancer (recurrence), or reduce the |
| chest drain insertion, in order to prevent the growth | | | | chance of developing a new type of cancer. |
| of the tumor along the track in the chest wall. | | | | Screening Trials - study ways to detect cancer. They |
| Chemotherapy - is used to stop the cancer cells from | | | | are often conducted to determine whether finding |
| growing and dividing. | | | | cancer before it causes symptoms decreases the |
| Immunotherapy: Heated Intraoperative Intraperitoneal | | | | chance of dying from the disease. These trials involve |
| Chemotherapy requires the removal as much of the | | | | people who do not have any symptoms of cancer. |
| tumor as possible followed by the direct | | | | Diagnostic Cancer Trials - develops new tests or |
| administration of a heated between (40 and | | | | scans |
| 48°C) chemotherapy agent, into the abdomen | | | | Treatment Trials - studies new drugs or combinations |
| for 60 to 120 minutes and then drained. | | | | of drugs; new ways of giving treatment, and new |
| Palliative Procedures | | | | types of treatment |
| Pleuroperitoneal Shunt is a procedure where a | | | | Quality of life trials explore ways to improve the |
| catheter is placed under the skin from the pleural to | | | | comfort and quality of life of cancer patients and |
| the peritoneal cavity. This procedure raising concerns | | | | cancer survivors. These trials may study ways to |
| as the catheter can cause damage by embedding | | | | help people who are experiencing nausea, vomiting, |
| itself into the abdomen. | | | | sleep disorders, depression, or other effects from |
| Pleurectomy, a palliative procedure, may be | | | | cancer or its treatment. |
| performed when more extensive surgery is not an | | | | Genetics Study Trials - are sometimes part of |
| option. The procedure does not effectively remove | | | | another cancer clinical trial. The genetics component |
| all tumors. It is considered the most effective means | | | | of the trial may focus on how genetic makeup can |
| of controlling pleural effusion (fluid buildup) in cases | | | | affect detection, diagnosis, or response to cancer |
| where the lung's expansion is restricted by the | | | | treatment. |
| mesothelioma. | | | | Clinical trials are conducted in 4 phases: |
| Potentially Curative Procedures | | | | Phase 1 trials look at whether a trial treatment drug |
| These procedures are performed with "curative | | | | is safe or has any harmful effects and attempts to |
| intent". | | | | establish the right dosage required. |
| Pleurectomy/Decortication is usually performed on | | | | Phase 2 trials look at the effectiveness of the |
| patients with early stage pleural mesothelioma | | | | treatment. |
| disease (Stage I and selected Stage II), and | | | | Phase 3 trials test a new treatment against the |
| attempts to remove all gross tumor. | | | | existing standard treatment. If it yields better results, |
| Extrapleural Pneumonectomy is surgery to remove a | | | | it may become the new standard treatment. |
| diseased lung, part of the pericardium, part of the | | | | Phase 4 trials are carried out after a drug has been |
| diaphragm and part of the parietal pleura. This type | | | | licensed. They collect information about side effects, |
| of surgery is used most often to treat malignant | | | | safety and the long term risks and benefits of a |
| mesothelioma and is combined with traditional | | | | drug. |
| chemotherapy and/or radiation, gene therapy, | | | | Ongoing research attempts to improve mesothelioma |
| immunotherapy or photodynamic therapy. | | | | treatment options but clinical trials will not all result in |
| Cytoreductive Surgery removes visible tumors in the | | | | new and better treatment. After testing, it may be |
| peritoneal cavity. The remaining cancer cells are | | | | discovered that the treatment being tested does not |
| treated by Intra-Peritoneal Hyperthermic (heated) | | | | work, or that it has worse side affects than existing |
| Chemotherapy (IPHC) and then delivered to the | | | | treatments. But, to researchers and doctors, and in |
| abdominal cavity. | | | | the end for patients, it is crucial to keep this research |
| New or Experimental Therapies | | | | going. |
| Gene Therapy: The best known tumor suppressor | | | | |