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The Patient Journey

Treatment

The extent of disease, overall health and patient’s wishes will influence treatment plans. Patients with extensive disease may decide not to pursue systemic treatment and instead focus on improving quality of life through symptom management. Patients with limited disease may explore more invasive and complex treatments. Some will enjoy life without treatment for a period under surveillance and others will start immediately.

Mesothelioma treatment impacts both the physical and emotional wellbeing of the patient, therefore the need to monitor for side effects related to their treatment and assess their mental health with referral to social work and psychology is paramount to providing good nursing care.

Chemotherapy

Since 2003 the standard treatment for pleural mesothelioma has been double chemotherapy with pemetrexed and cisplatin/carboplatin. It remains a standard first line treatment for epithelioid mesothelioma but is less effective for sarcomatoid and biphasic subtypes of mesothelioma.1,2

Immunotherapy

Immunotherapy is a targeted treatment that uses immune checkpoint inhibitors (ICI) to prompt an anti-tumour immune response, allowing T-cells to attack tumour cells. Recent studies have concluded that double immunotherapy using Nivolumab (Opdivo) and Ipilumumab (Yervoy) should be the new standard of care for first line treatment in patients with non-epithelioid mesothelioma and may be of comparable efficacy to chemotherapy in epithelioid disease.1,3 Prior to 2021 these drugs were not listed on the Pharmaceutical Benefit Scheme (PBS) and the cost to the patient impacted choice and availability. Pembrolizumab (Keytruda) is a single immunotherapy drug that was the basis of initial clinical trials of immunotherapy in mesothelioma care.3,4

Other Therapies

Bevacizumab is an antiangiogenic agent that inhibits the production of tumour blood vessels which limits blood supply, slowing the growth and spread of tumours. Results suggest that Bevacizumab in combination with chemotherapy may be a potentially life-extending treatment as well as beneficial in palliative symptom management.5

Radiation Therapy

Radiation therapy is used to reduce the size and spread of tumours and consequential pain relating to tumour activity. Specialised radiation therapy is used as the third treatment arm of trimodality therapy.

Clinical trials

As research in mesothelioma evolves, so do treatment options. Current trials are looking at the efficacy of combination chemotherapy and immunotherapy and other targeted therapies in the treatment of mesothelioma. Patients should be informed by their healthcare team of any clinical trials they may be eligible for.

Visit the Thoracic Oncology Group of Australasia (TOGA) for more information on current clinical trials and research.

Surgery

Surgical intervention aims to control recurrent pleural effusions and optimise lung function by removing the fluid and re-expanding the affected lung. For many patients, surgery to control the fluid will be all they require. Others may require more invasive procedures to reduce disease activity and enable better lung function, and ultimately prolong quality living.

References

  1. Nowak AK, Jackson A, Sidhu C. Management of advanced pleural mesothelioma—at the Crossroads. JCO Oncology Practice. 2022;18(2):116-124.
  2. Vogelzang N. J, Rusthoven J. J, Symanowski, J, et al. Phase III study of pemetrexed in combination with Cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. Journal of Clinical Oncology, 2003;21(14):, 2636-2644.
  3. Metaxas Y, et al. Pembrolizumab as Palliative Immunotherapy in Malignant Pleural Mesothelioma. Journal of Thoracic Oncology, 2018;13(11): 1784-1791.
  4. Gray SG, Mutti L. Immunotherapy for mesothelioma: A critical review of current clinical trials and future perspectives. Translational Lung Cancer Research. 2020;9(S1).
  5. Zalcman G, Mazieres J, Margery J, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): A randomised, controlled, open-label, phase 3 trial. The Lancet. 2016;387:1405-1414.