At the Swedish Cancer Institute, we have a strong focus on treating malignant pleural mesothelioma. Our experienced specialists work together as a team to develop the best treatment plan for each of our patients.
The treatment plan will vary from patient to patient. Given our broad experience with mesothelioma and the treatment options, we have choices that can be offered to patients to personalize treatment, depending on the tumor and patient. One form of treatment that patients may receive (and is the best chance for cure) is the trimodality approach, incorporating chemotherapy, surgery and radiation (in variable order).
Chemotherapy is the only standard treatment for mesothelioma. The combination of Pemetrexed and Cisplatin (and Bevacizumab in certain patients) are recognized as the standard chemotherapy regimen for pleural mesothelioma. For patients deemed to have pleural mesothelioma not amenable to surgery, the FDA recently approved combination immunotherapy with nivolumab and ipilimumab as a first-line treatment (CheckMate-743 trial). This study demonstrated a significant survival advantage in patients treated with immunotherapy versus standard chemotherapy. The utilization of immunotherapy in both potentially operable and non-operable patients is expected to increase in the upcoming years. Chemotherapy or immunotherapy can usually be coordinated close to a patient's home.
The most commonly performed surgery is either the extra pleural pneumonectomy (EPP), which removes all disease, the lung and diaphragm; or the lung-sparing extended pleurectomy/decortication (eP/D), which removes the lining of the affected lung, in addition to the affected pericardium and diaphragm, but does not remove the lung. We have extensive experience in both types of surgery for mesothelioma and keep all options open during the evaluation period.
Radiation treatment for mesothelioma requires a specialized treatment protocol. The radiation oncologists at the Swedish Cancer Institute have a long history of delivering innovative therapy and are experienced in minimizing the exposure of the unaffected lung to radiation through complex radiation simulation and planning.
Researchers at the Swedish Cancer Institute participate in clinical trials and innovative therapy in all aspects of the treatment of mesothelioma. This includes surgery, radiation, systemic therapy and supportive care. Several clinical trials are available at Swedish for patients with pleural mesothelioma, with several more planned in the upcoming years.
With lung-sparing surgery (eP/D) becoming increasingly common for mesothelioma, the safe delivery of post-operative radiotherapy has become more complex. This treatment aims to decrease the risk of local-regional tumor in the setting of two intact lungs. The lung is particularly sensitive to radiation, and conventional hemithoracic radiation is unable to spare the underlying lung, resulting in significant toxicity and lung damage if used. As a result, a novel, conformal, intensity-modulated pleural radiation therapy (IMPRINT) has recently been developed which aims to target the affected pleura while sparing damage to both lungs –not only the side without the mesothelioma. Early single-institution studies have demonstrated this radiation technique to be safe and it is now being evaluated in a multi-institution, randomized Phase III clinical trial. Given the importance of identifying a multimodality therapy for pleural mesothelioma to reduce recurrences, we are actively enrolling qualifying patients onto this clinical trial.
The incorporation of novel immunotherapies into the treatment of both resectable and unresectable pleural mesothelioma patients has been a focus of a large amount of recent research and clinical trials. Immunotherapies aim to harness a patient’s own immune system to fight cancer. The Swedish Cancer Institute is participating in clinical trials investigating the use of immunotherapy –, either alone or in combination with standard-of-care chemotherapy – and we are recruiting patients or in the process of opening new trials in this area. This represents one of the more exciting aspects of mesothelioma treatment and potentially represents a major advance in improving both quality of life and survival.