Multimodal therapy combines more than one cancer treatment. Surgery with chemotherapy and radiotherapy is a general approach to mesothelioma treatment. The mixture can also be supplemented with experimental treatments such as immunotherapy and gene therapy.
Although each treatment option can have a positive impact on patients, mesothelioma specialists achieve the best results by combining different treatments that control, remove and kill cancer cells. Clinical studies have proven that this approach improves survival rates for patients who are healthy enough to qualify for aggressive cancer treatment.
The doctors sometimes use a more specific term for a multimodal treatment plan. In "Bimodal Therapy" combines two treatments and "Trimodal Therapy" combines three treatments. A multimodal treatment approach usually focuses on greater tumor treatment, with chemotherapy and radiotherapy being performed before, after, or even during surgery.
- In peritoneal mesothelioma, cytoreductive abdominal surgery in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is the most effective treatment approach.
- For the pleural mesothelioma, there is no single treatment plan that is clearly better than any other this depends on the specific circumstances of the patient and the judgment of his doctors.
Not all mesothelioma patients are candidates for a multimodal therapy approach, and aggressive cancer treatments are always associated with toxicity or complication risks.
Who Is Suitable For a Multimodal Treatment?
A patient's treatment plan depends on several factors, including the stage and type of cancer and the health of the patient. The stage of mesothelioma refers to how far cancer has progressed and spread throughout the body. Early cancer is small and localized, making it easy to target multimodal therapy.
However, late-stage cancer may already be so prevalent that trying to completely remove it may do more harm than good to the patient. For advanced patients, physicians typically recommend less invasive palliative treatments that alleviate the symptoms.
The cell type of a mesothelioma tumor influences how well it responds to the treatment. Epithelial tumors are easier to remove during surgery and respond better to chemotherapy. Patients with this type of mesothelioma have a greater chance of benefiting from multimodal treatment.
Health Factors That Determine Eligibility For Cancer Treatment
- Surgeons need to make sure that the patient's body is strong enough to heal from major surgery.
- Oncologists need to analyze the body chemistry of the patient to make sure the chemo is not too toxic.
- Radiologists must check that the patient has reached the limit of the radiation exposure that he can safely receive.
Many patients are not fit for aggressive treatment for health reasons. Due to the high cost of cancer treatment, multimodal therapy is unattainable for many patients.
Multimodal Treatment Strategies
The treatments in multimodal therapy fall into three categories. The difference is between the timing of each treatment relative to the others.
Neoadjuvant Therapy
This is given in the weeks or months before the primal therapy. In certain cases, doctors administer chemotherapy before surgery to reduce the size of the tumors. It increases the chance of complete removal during surgery.
Primary Treatment
This is the potentially most effective treatment option. For mesothelioma patients, this usually means surgery. Surgeons can perform targeted treatments such as intraoperative chemotherapy or photodynamic therapy immediately after tumor removal before surgery is complete.
Adjuvant Therapy
This is given in the weeks or months after the primal therapy. It is common for doctors to do chemo after surgery to kill cancer cells left in the body. Sometimes doctors also try to prevent the recurrence of cancer by radiation. They irradiate the empty space left by a distant lung or direct small radiation doses along the interface.
Select the Right Treatments
Doctors are still experimenting to find the most effective combination of therapies for the treatment of pleural mesothelioma. Most specialists recommend a three-part approach that combines surgery with adjuvant chemotherapy and radiotherapy.
When developing a multimodal treatment strategy, a medical team assesses each case individually. They weigh the risks and benefits of possible treatments based on the unique situation of the patient. The team recommends combining treatments that offer the most hopeful outlook.
If the patient responds poorly or particularly well to treatment, the team can adjust the treatment plan accordingly. You can add a more promising treatment option, replace an ineffective one or adjust the dose of an existing one.
Multimodal Therapy Breakthroughs In Mesothelioma
In recent years, mesothelioma specialists have begun to combine traditional therapies with experimental treatments. New technologies include the immunotherapy, gene therapy, and photodynamic therapy. Currently, such new treatments are only available to patients participating in a clinical trial.
Photodynamic Therapy Prolongs Survival For Years
A 2017 study published in the Annals of Thoracic Surgery examined patients with pleural mesothelioma treated with a combination of surgery, chemotherapy and photodynamic therapy. The patients had a median survival of three years, and 19 of the study's 73 patients lived more than seven years.
The University of Pennsylvania Abramson Cancer Center has been sponsoring an ongoing Phase 2 clinical trial of this novel multimodal approach since 2014. A 2017 study of 73 epithelioid patients combined a multimodal approach with photodynamic therapy with long median survival times.
Keytruda Shows Promising Results
The immunotherapeutic pembrolizumab has shown efficacy in mesothelioma patients in clinical trials. Merck & Co. markets it under the brand name Keytruda. Pembrolizumab shrank tumors in more than half of the mesothelioma patients in a clinical trial under the Merck Access program. All patients had previously received chemotherapy.
In 2016, a phase I clinical trial began in which pembrolizumab was multimodally tested as neoadjuvant and adjuvant treatment. Doctors combine this with a lung sparring operation and standard chemotherapy.
WT1 Vaccine a Possible Second Treatment
A novel DNA vaccine designed to increase the chances of inducing anti-tumor immunity could become a second treatment for mesothelioma. The doctors use second-line treatments when first-line treatments such as chemotherapy stopped working.
In 2016, the FDA awarded Fast Track the WT1 cancer vaccine, also called Galinpepimut-S. The immunotherapeutic aims at the WT1 protein. Which is expressed in high amounts in mesothelioma. Mesothelioma patients in Phase II clinical trial for the WT1 vaccine had a median survival of 24.8 months compared to only 16.6 months in patients receiving placebo.
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