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mesothelioma treatmentMesothelioma is an aggressive disease that requires an equally aggressive treatment strategy. Mesothelioma is resistant to many standard cancer treatments, making it a difficult disease to manage. Treatment plans consists of chemotherapy, and surgery or radiation when a multi-modal approach is used.

Treatment for the asbestos cancer is classified as one of two types — curative or palliative. Curative therapy focuses on killing the cancer cells and stopping further growth. Palliative care treatments aim at relieving the symptoms and improving the patient’s quality of life.

Regardless of the approach taken, the primary doctor will closely monitor the patient’s response to therapy and make any needed adjustments to the treatment plan. In many instances, a patient will begin treatment with an aggressive protocol, but will be transitioned to a more palliative treatment plan if the disease stops responding to the aggressive therapies.

An empowered mesothelioma patient is often the best patient for a medical team. Empowered patients are informed of their disease’s track and treatment options, and they are willing to take an active role in their treatment strategies.

Knowing what questions to ask of your physician is an important step toward becoming an empowered mesothelioma patient. Learning about the benefits and risks of each of the options below is critical to ensuring you are prepared for the arduous battle ahead. Listen closely to your doctor, and ask enough questions to get the full picture.

Traditional Treatments and Therapies

1. Surgery (physical removal of the cancer)

surgery

Surgery involves the physical removal or other operative treatment of the cancer. There are several surgeries available for patients, some of which are used palliatively to treat symptoms and some of which are considered radical surgery, such as removal of one of the lungs, and used with curative intent. The physician will decide the nature and type of surgery to be performed based on his or her overall treatment strategy and the information determined during the patient’s workup

2. Chemotherapy (using drugs to fight the cancer)

chemotherapy

Chemotherapy uses drugs and other chemicals to kill cancer cells. Treatment with chemo is considered “systemic treatment” because drugs are introduced via the bloodstream and kill cancer cells throughout the body. Pemetrexed-based chemotherapy is the standard of care for mesothelioma cancer and has improved chemo treatment efficacy compared to older chemotherapies.

3. Radiation Therapy (using radiation to kill cancer cells)

radiation therapy

Radiation therapy uses ionizing radiation to destroy cancer cells and shrink tumors. Radiation can be used as part of a multimodal treatment protocol, or it can be used in a palliative manner to reduce the pain associated with the disease.

Recent advances in understanding mesothelioma’s complex biology have led to improvements in the effectiveness of the standard therapies. Those advances are reflected in an increase in median survival times reported by some classes of patients. Much more research needs to be done before the medical community can say it has turned a corner in the treatment of mesothelioma. Even so, the increase in survival times in patients treated with an effective multimodal protocol points to a new level of hope for mesothelioma patients.

Mesothelioma Alternative Treatments

A new generation of cancer drugs that target specific genes have the potential to revolutionize oncology. While several of these treatments remain in late-stage human testing, others, including Gilotrif (afatinib), have already been approved by the U.S. Food and Drug Administration (FDA).

Gilotrif tablets are FDA-approved for the treatment of patients with non-small cell lung cancer (NSCLC), which represents about 85 percent of lung cancers. A tyrosine kinase inhibitor, Gilotrif blocks proteins that promote the development of cancerous cells. It is meant for NSCLC patients whose tumors express specific types of epidermal growth factor receptor (EGFR) gene mutations, present in about 10 percent of NSCLC and over 50 percent of pleural mesothelioma patients. The EGFR biomarker is detected by the therascreen EGFR RGQ PRC Kit. Gilotrif and the diagnostic kit were concurrently approved by the FDA in July 2013.

Approval Based on Improved Progression-Free Survival of Trial Patients

Approval of afatinib was based on a trial of 345 patients with metastatic NSCLC whose tumors tested positive for EGFR mutations. A statistically significant prolongation of progression-free survival (PFS) among afatinib recipients was determined by an independent review committee (IRC). The delay in tumor growth was 4.2 months later for patients receiving Gilotrif than for those receiving chemotherapy, although there was no statistically significant difference in overall survival between the two.

Gilotrof is one of a promising new class of drugs known as “targeted treatments” that are based on an understanding of the underlying molecular pathways of cancer. Targeted therapies tend to be less toxic to the body overall than traditional cancer drugs because they are able to more accurately target malignancies while sparing healthy tissue.

Traditional Cancer Treatments Ineffective for Mesothelioma

More than 228,000 Americans will be diagnosed with lung cancer this year, and approximately 159,000 will die from the disease.

Mesothelioma is a type of incurable lung cancer that mostly affects the cells covering the lungs (the pleura). Around 3,000 new cases are diagnosed in the U.S. each year. Mesothelioma responds poorly to the traditional cancer treatment methods of surgery and chemotherapy, making it critical to find new treatments that stop or slow down the disease progress.

Gilotrif was the second drug in 2013 approved specifically for patients whose NSCLC tumors have EGFR mutations. It was developed by Boehringer Ingelheim Pharmaceuticals, Inc., headquartered in Ingelheim, Germany. The therascreen EGFR RGQ PCR is manufactured by QIAGEN Manchester Ltd., based in the United Kingdom.

What steps can one take to receive the best treatment?

Clinical Trials Aiming to Find a Cure for Mesothelioma

 Stem Cell Targeting Cancer Drug May Suppress Mesothelioma

There is no cure for mesothelioma, but everyday there are different researches and clinical trials going on trying to find a better treatment and cure. An experimental drug known as defactinib (VS-6063) offers hope to patients with mesothelioma, a fast-spreading and incurable form of cancer that mostly affects the pleura, the cells covering the lungs.

Defactinib, developed by Cambridge, Massachusetts-based Verastem, Inc. (NASDAQ: VSTM) has been granted orphan drug designation in the U.S. and E.U. for use in mesothelioma. It is in the late stages of human testing, with trials ongoing in 8 countries.

Defactinib targets cancer stem cells, the cells that divide and grow a tumor, through the inhibition of focal adhesion kinase (FAK). Previous research by Verastem has shown that the FAK pathway is critical for the growth and survival of cancer stem cells.

COMMAND Study to Evaluate Effect of Defactinib

Verastem announced in September 2013 the initiation of COMMAND (Control of Mesothelioma with MAiNtenance Defactinib), a registration-directed, doubled-blind, placebo-controlled trial of defactinib in patients with mesothelioma that has Progression Free Survival (PFS) and Overall Survival (OS) as the primary endpoints.

COMMAND seeks to build upon preclinical and early clinical research that demonstrates patients with tumors low in the biomarker merlin respond well to FAK inhibitors. Merlin, which negatively regulates FAK, is produced by a gene called Neurofibromatosis 2 (NF2). NF2 is inactive in around half of mesothelioma patients.

Patients in 11 countries, including the U.S., U.K. Australia, Canada, and Japan are expected to enroll in COMMAND. March 2014 findings from a First-in-Asia Phase 1 clinical trial of VS-6063 in Japan showed that the drug was well-tolerated at each dose level, consistent with results from a Phase 1 U.S. clinical trial.

UPDATE: Verastem announced in Sept. 28 2015 that is halting its COMMAND clinical trial.

Incidence of Mesothelioma Increasing Worldwide

Japan banned asbestos in 2006, and the World Health Organization has warned that Asian governments should be prepared for an “asbestos tsunami.” Asbestos is still not completely banned in the U.S.

“The incidence of mesothelioma is increasing worldwide, underscoring an urgent need to expand the very limited treatment options for patients fighting this disease,” said Professor Dean Fennell, Chair of Thoracic Medical Oncology at the University of Leicester and Coordinating Investigator for COMMAND in the UK. “In the early ‘70s, this was an incredibly rare disease. Now my clinic is full of patients with mesothelioma,” he said.

Fennell hopes that drugs like VS-6063 can suppress mesothelioma so that it becomes more of a chronic disease that patients can live with, rather than a fatal disease that rapidly kills them. Mesothelioma patients are typically given as little as 9-17 months to live after diagnosis. The disease has a survival rate of less than 5 percent.

New Drug Shows Promise in Slowing Spread of Disease

Preliminary findings from a phase I clinical trial of a new mesothelioma treatment indicate that a drug known as GSK2256098 may help prevent the spread of the disease in patients who lack a certain tumor-suppressor gene.

Therapeutic Targets Potential Biomarker for Meso

The gene, called Neurofibromatosis 2 (NF2), is inactive in around half of mesothelioma patients. NF2 produces merlin, which functions as a tumor suppressor protein. Merlin negatively regulates another protein called focal adhesion kinase (FAK) in mesothelioma cells. When both NF2 and merlin are inactivated, FAK activity is increased and mesothelioma cells become invasive and start to spread. Restoring NF2 and merlin activity leads to a decrease in cell invasion.

To conduct the phase I study of GSK2256098, researchers in France, Australia, and the United Kingdom administered the drug to 29 mesothelioma patients at an average dose of 1000 mg/day. Patients in whom merlin was inactivated had an average of 24 weeks before the disease progressed, compared to 11 weeks in patients with active merlin.

Jean-Charles Soria, head of drug development at the Institut Gustave Roussy in Paris and a lead researchers of the clinical trial described how, “A patient with mesothelioma, who had progressed quickly on prior therapies, had prolonged stable disease while on GSK2256098, which is suggestive of clinical activity.”

While the clinical trial revealed no serious side effects, Soria noted the findings are still preliminary. “They show that merlin is a potential biomarker in mesothelioma that may enable us to identify a subset of patients who could benefit from GSK2256098 and have longer, progression-free survival,” he said.

New Treatments Sought for Incurable, Fast-Spreading Disease

Mesothelioma is a type of aggressive, incurable cancer that primarily affects the cells covering the lungs. Approximately 3,000 Americans are diagnosed with mesothelioma each year and in 2013, more than 100,000 patients worldwide died from the disease.

Mesothelioma patients are often given as little as 9-17 months to live after diagnosis. Current treatments include surgery to remove cancerous areas and chemotherapy, although these treatments carry dangerous side effects and are limited in their effectiveness against mesothelioma. Stopping or slowing the spread of the cancer with drugs such as GSK2256098 would make it more like a chronic disease rather than a rapidly-spreading fatal disease.

Mesothelioma patients are often given as little as 9-17 months to live after diagnosis. Current treatments include surgery to remove cancerous areas and chemotherapy, although these treatments carry dangerous side effects and are limited in their effectiveness against mesothelioma. Stopping or slowing the spread of the cancer with drugs such as GSK2256098 would make it more like a chronic disease rather than a rapidly-spreading fatal disease.

  1. Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York. 2005.
  2. De Perrot, M., Feld, R., Cho, B.C. J., Bezjak, A., Anraku, M., et al.. Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. Retrieved from http://jco.ascopubs.org/content/27/9/1413.abstract?ijkey=cc3963ea9a3a4bb5b4de2a5ed1215dfe6c125413&keytype2=tf_ipsecsha
  3. Munkholm-Larsen, S., Cao, C. Q., & Yan, T. D. (2009). Malignant pleural mesothelioma. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999110/?tool=pubmed
  4. Stahel, R.A., Weder, W., Lievens, Y., & Felip, E. (2010). Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Retrieved from http://annonc.oxfordjournals.org/content/21/suppl_5/v126.long
  5. U.S. Food and Drug Administration: FDA approves new treatment for a type of late-stage lung cancer
  6. Bloomberg News: Asbestos-Linked Cancer Targeted in Novel Drug Approaches
  7. Drugs.com: Verastem Initiates Registration-Directed Trial of Defactinib in Patients with Mesothelioma
  8. Business Wire: Verastem Reports Data from Phase 1 Study of VS-6063 (defactinib) in Japanese Patients
  9. European Cancer Organisation: Mesothelioma drug slows disease progression in patients with an inactive NF2 gene

About the Author - 

Nancy is a blog and content writer with more than 20 years of professional experience. Nancy has been writing about mesothelioma and cancer for close to five years.

Published: Feb 11, 2013 - Updated: Feb 23, 2016
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