In recent years, the US Food and Drug Administration has approved new therapeutic techniques for new mesothelioma treatments. Malignant pleural mesothelioma has been difficult to treat and the lack of positive results from treatment has made research imperative. Pleural mesothelioma is by far the most common type of mesothelioma, which begins in the lining of the lungs. It affects approximately 75% of all mesothelioma victims.
Diagnosing Mesothelioma
A CT scan is usually used to diagnose pleural mesothelioma and to continue monitoring how the cancer progresses through treatment. Some things that could show up on a CT scan include pleural effusion, pleural plaques, and diffuse pleural thickening.
Normally, the goal of surgery is macroscopic complete resection. Pleurectomy decortication as well as extended pleurectomy decortication have been used in place of extrapleural pneumonectomy in many cases.
Radiation therapy is used to manage pleural mesothelioma and can be used in many ways. It can be administered in adjuvant, neoadjuvant, or palliative settings. If the malignant pleural mesothelioma is resectable, meaning that it can be removed by surgery, radiation therapy is usually administered to the hemithorax either prior to or after non-lung sparing surgery, such as extrapleural pneumonectomy.
When the mesothelioma tumor is resectable, currently, there are usually four cycles of neoadjuvant or adjuvant cisplatin-pemetrexed therapy. There are numerous clinical trials going on that have the goal of helping us understand the benefits of immunotherapy when it comes to treating mesothelioma.
FDA Approval For New Mesothelioma Treatments
When it comes to unresectable disease, or a tumor that cannot be removed through surgical procedure, the previous standard of care in the US was four to six cycles of therapy of platinum-pemetrexed with and without bevacizumab. This was then followed by maintenance therapy. In 2019, the FDA approved NovoTTF for the treatment of pleural mesothelioma. NovoTTF is a portable biomedical device that creates electrical fields in the torso that alternate. For 18 hours a day, mesothelioma patients would keep transducer arrays on their chest. TTFs, or tumor treatment fields are thought to harm cancer cell division.
The CheckMate 743 trial was a trial that compared platinum-pemetrexed to ipilimumab-nivolumab in mesothelioma patients who had not received prior treatment. There was an overall survival benefit in the population that was treated.
In general, there is still a lot more research that needs to be done when it comes to determining the best treatment options for mesothelioma. Treatment can also depend on how progressive the cancer is and the patient’s physical condition. It is promising that the FDA has approved some new treatment modalities.
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