Before 2020, the normal standard of treatment in the first line setting for those with pleural mesothelioma was chemotherapy, with a combination of platinum and pemetrexed. The CheckMate 743 trial showed promising results for another form of treatment in 2020, which was then approved for use. This treatment involved a multimodality approach by combining immunotherapy with nivolumab and ipilimumab. The CheckMate 743 trial showed that patients that were treated using this approach survived longer than those treated using the previous standard of first-line treatment.
Symptoms
Those who have pleural mesothelioma usually have dyspnea, or difficult or labored breathing, due to a pleural effusion, which is when fluid builds up in the lungs. Other symptoms include chest pains, masses in the chest and other systemic symptoms such as weight loss, night sweats and/or fever.
Diagnosis
A biopsy is usually needed to officially diagnose mesothelioma, whether that be taken under CT guidance or during video-assisted thoracoscopic surgery (VATS). A biopsy is the best way to check for mesothelioma because a tissue sample allows for the examination of stromal features and architectural patterns.
Deciding on Treatment
When it comes to deciding which treatment a patient should undergo, imaging tests become very important. This is because imaging tests determine whether the mesothelioma tumor resectable or unresectable, meaning whether it can be removed using surgery. A contrast-enhanced CT scan can be used for many different things, including detecting pleural effusion, pleural nodularity, lymphangitis, and organ, chest wall or diaphragmatic invasion. Magnetic resonance imaging (MRI) may be used when surgery is being considered to determine the severity and location of the disease, as it can see the extent of both chest wall and organ involvement.
Biomarkers
Serum biomarkers have been researched in regard to early detection, diagnosis and monitoring of those with mesothelioma. These include serum mesothelioma, micro-RNAs, fibulin-3 and neutrophil to lymphocyte ratio. Despite these biomarkers being investigated, there is one biomarker that has been approved by the FDA and that is mesothelin.
There is thought to be a predisposition for cancer for more than 10% of people who develop mesothelioma. The most common of these are mutations causing BAP1 loss. Germline mutations in many other cells have been identified including MSH3, BRCA2, PALB2, CHEK2, POT1, PALB2 and more.
Surgery
When it comes to treatment for pleural mesothelioma, surgery has been a controversial subject, but there are a few elements of the process that are agreed upon. Selection of patients is important as well as the assessment of certain factors such as performance status, comorbidities and age. Usually those with sarcomatoid mesothelioma are not eligible for surgery. There are two different surgical approaches when it comes to treating mesothelioma: extrapleural pneumonectomy or extended pleurectomy decortication.
CheckMate 743 Trial
The CheckMate 743 trial showed that combination immunotherapy could be the new standard when it comes to treating patients with mesothelioma. This trial was a phase III study that included patients that had advanced pleural mesothelioma with no chance of curative therapy. Overall, patients who received combination immunotherapy survived an average of four months longer than those who just received chemotherapy alone.
Palliative Care
Managing symptoms of mesothelioma is important to maintain a decent quality of life. Those with pleural mesothelioma may experience a lot of symptoms, so palliative care is essential. Palliative radiotherapy is usually recommended to manage localized disease because it significantly reduces pain.
Pleural effusions are very common for those with pleural mesothelioma. 80 percent to 95 percent of patients with mesothelioma end up developing a pleural effusion. There are systems that can be used to drain the fluid in the lungs including inserting a catheter, VATS, or interval large-volume thoracocentesis.
If you or a loved one has been diagnosed with mesothelioma or another asbestos-related disease, please call (800) 505-6000 or fill out the form on our Homepage for more information.
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