Mesothelioma Management

Mesothelioma Management


Mesothelioma management can be in the form of surgery combined with chemotherapy. In addition, patients may also receive radiotherapy. As of October 2020, the FDA has also approved immunotherapy with the combination of nivolumab and ipilimumab as the first-line therapy for unresectable metastatic pleural mesothelioma.

Surgery

The main surgical technique in peritoneal mesothelioma is a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). The average life expectancy of patients can reach 53 months and life expectancy is 5 years can reach 47%.

The CRS-HIPEC technique has a fairly high probability of morbidity and mortality. However, when the surgery is performed in an institution with good experience and equipment, the mortality rate ranges from 0-8% and the morbidity rate due to serious complications ranges from 10-45%.

In pleural mesothelioma patients (especially early-stage ones), the main principle of surgery is to remove the mesothelial layer, one or more lymph nodes, or part or all of the lung or other organ. Surgical methods commonly used are pleurectomy/decoration (P/D) and extrapleural pneumonectomy (EPP).

Chemotherapy

For patients who cannot undergo surgery, systemic chemotherapy may be an alternative. The preparation used is a combination of pemetrexed with cisplatin or carboplatin. Carboplatin is more advisable for geriatric patients and for palliative therapy because it is better tolerated than cisplatin.

In addition to these combinations, currently, the combination of gemcitabine and pemetrexed can also be an alternative for pleural mesothelioma patients. This combination is being further studied as second-line therapy when pemetrexed and cisplatin/carboplatin do not give a good effect.

Radiotherapy

Malignant pleural Mesothelioma is generally resistant to radiotherapy. However, the development of increasingly sophisticated radiotherapy techniques (such as intensity modulated radiation therapy or IMRT) has allowed the application of radiotherapy in mesothelioma patients. Radiotherapy is suggested as palliative therapy to reduce chest pain and bronchial or esophageal obstruction.[12]

Immunotherapy

In October 2020, the FDA approved the combined use of nivolumab and ipilimumab as first-line therapy for unresectable malignant pleural mesothelioma. According to clinical trials in this case, immunotherapy provides better overall survival than chemotherapy.

Source

Kim J, Bhagwandin S, Labow DM. Malignant peritoneal mesothelioma: a review. Ann Transl Med. 2017;5(11):236. DOI: 10.21037 / atm.2017.03.96

Samara TD, et al. Mesothelioma due to inhalation of asbestos dust. J Health Biomedicine. 2020;3(4):193-200. DOI: 10.18051/JBiomedKes.2020.v3.193-200.

Tan WW. Mesothelioma. Medscape. 2020. https://emedicine.medscape.com/article/280367-overview

Ahmed I, Ahmed Tipu S, Ishtiaq S. Malignant mesothelioma. Mr. J Med Sci. 2013 Nov;29 (6):1433-8. DOI: 10.12669/pjms.296.3938

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