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Clinical Trials Continue to Support Multimodal Therapy for Mesothelioma

nurse with female patientThe Environmental Working Group estimates that the incidence of malignant mesothelioma will continue to increase for another 10 years or so. This is cause for concern because there is no standard treatment strategy for this disease, which in turn underscores the need for more research.

At Kazan Law, we are happy to keep tabs on the latest developments. For years, scientists have known that mesothelioma patients are unlikely to be cured because of the use of any single treatment, whether it is chemotherapy, radiation therapy or even surgery. However, patients may have more success if their doctors administer multiple treatments.

One team of researchers from Italy recently published the results of a study that supports this approach.

Mesothelioma requires intense treatment
Scientific research to determine the best treatment for a disease usually requires that different strategies be compared against each other. Because mesothelioma is relatively rare compared to other diseases, this task has proved exceedingly difficult, according to experts from the American Cancer Society. Furthermore, the cancer is hard to approach because it can spread easily and does not grow as one single mass of tumorous tissue.

However, there is evidence showing that patients benefit the most from a regimen that combines several different treatments, a strategy known as multimodal therapy. This includes:

  • Chemotherapy to shrink the cancer. Cisplatin and pemetrexed are two of the most common drugs that doctors use. While cisplatin damages the DNA of cancer cells in order to keep them from dividing, pemetrexed prevents the cells from actually making this DNA, as stated by the National Cancer Institute.
  • Surgery to remove the diseased tissue. One procedure is the extrapleural pneumonectomy (EPP). Experts from the University of California in San Francisco describe this procedure as one that excises an entire lung, plus portions of the diaphragm, pleura and the lining of the heart.
  • Radiation therapy to kill any abnormal cells left behind.

New study supports multimodal therapy
There have been several studies that show multimodal therapy may be a good approach for mesothelioma patients. Based on the success of this research, the team of scientists from Italy conducted their own study to investigate the impact of this regimen. In this study, subjects who were diagnosed with mesothelioma underwent three cycles of chemotherapy that combined cisplatin with pemetrexed, an EPP three to eight weeks later, and radiation four to eight weeks after surgery.

The researchers initially enrolled 54 patients, all of whom had mesothelioma between Stages I and III. Ninety-six patients completed chemotherapy, 83 percent underwent EPP and 41 percent completed all three segments of the multimodal therapy.

Results showed that the median amount of time in which patients lived without any significant deteriorations was 6.9 months. The median overall survival time was 15.5 months. One-third of study participants still had event-free disease after one year. After two years, that figure was almost one-fourth.

“The combination of pemetrexed plus cisplatin followed by surgery and hemithoracic radiation is feasible and has a manageable toxicity profile in carefully selected patients. It may be worthy of further investigation,” the scientists wrote in the journal BMC Cancer.

However, the researchers also noted that two subjects died due to complications from radiation therapy. After this happened, the scientists adjusted their experiment by using lower doses of radiation for subsequent patients. This underscores the need for physicians to select the candidates for certain treatments, such as radiation therapy and surgery, very carefully.

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