Key Takeaways
- Advances in mesothelioma treatment are happening across multiple areas — including genetics, imaging, surgery, radiation therapy, and emerging T-cell therapies.
- The gene BAP1 is the most commonly mutated gene in mesothelioma. Researchers have discovered that BAP1 mutations are frequently caused by chromothripsis — a catastrophic event in which thousands of chromosomal rearrangements occur simultaneously within a localized region of a chromosome.
- Imaging advances include diffusion-weighted MRI, which is being investigated to help determine whether pleural disease is malignant or benign — a critical step in treatment planning.
- In surgery, pleurectomy decortication (P/D) and extended P/D have largely replaced extrapleural pneumonectomy (EPP) as the preferred approach because of lower mortality and morbidity rates.
- Only 60% to 80% of patients who are planned for mesothelioma surgery actually undergo the procedure — often because the patient’s physical condition at the time of surgery doesn’t allow it.
- Radiation therapy can be used in neoadjuvant (before surgery), adjuvant (after surgery), and palliative (symptom management) settings. Newer radiation methods are being developed to minimize damage to surrounding tissue.
Traditionally, mesothelioma is associated with very few treatment options. However, the US Food and Drug Administration has approved certain standards of care that could streamline new mesothelioma treatments and help with affecting prognosis in a positive way. Over the past couple of years there have been advances in radiology, surgery, radiation, medical oncology, and chromothripsis. Chromothripsis is a process in which thousands of clustered chromosomal rearrangements take place in a single event in localized and confined regions in one or a couple chromosomes. There have also been advances in potential T-cell therapies for new mesothelioma treatments.
Genes
BAP1 is the gene that is mutated most in mesothelioma. Through an advanced technique it was found that BAP1 is commonly affected by chromothripsis, which I described earlier. In other words, chromothripsis takes place due to “numerous double-strand breaks of a large segment of a chromosome or a whole chromosome that has been likened to the shattering of a chromosome.” Fixing these breaks in chromosomes causes many rearrangements and copy-number changes. Evidence for chromothripsis in mesothelioma was seen in a study of 22 specimens, in which 1,535 chromosomal rearrangements were seen. Understanding this whole process better could result in new mesothelioma treatments.
Imaging Tests to Determine New Mesothelioma Treatments
A CT scan is normally used to determine if someone has mesothelioma, particularly with pleural mesothelioma, which originates in the lining of the lungs. CT scans can detect pleural thickening, pleural plaques, and pleural effusion – which are all evidence of the effects of asbestos in the lungs.
Metabolic imaging is used to determine the extent of the mesothelioma, particularly in those in which resection, or complete removal of the tumor by surgery, may be an option. An MRI is frequently used to look at the chest wall and over the past couple of years diffusion-weighted MRI has been investigated to determine if the disease is malignant or not.
New Mesothelioma Treatments in Surgery
When it comes to surgery for mesothelioma, the goal is complete resection. When it comes to new mesothelioma treatments, pleurectomy decortication or extended pleurectomy decortication has widely replaced the standard of an extrapleural pneumonectomy (EPP). This is most likely because pleurectomy is associated with lower mortality and morbidity when compared to EPP. Although you may think surgery is the ideal treatment option, sometimes planned surgeries do not take place due to the patient’s physical condition. Only 60 percent to 80 percent of patients that are supposed to undergo surgery will end up getting that surgery.
Radiation Therapy
Radiotherapy can be administered in a multitude of different ways when it comes to treating mesothelioma. It can be used in the adjuvant, neoadjuvant, and palliative settings. When malignant pleural mesothelioma is in the early stages, radiotherapy is usually delivered to the hemithorax either before or after surgery. For new mesothelioma treatments, it is better to use newer methods of radiation therapy to keep damage to the surrounding tissue at a minimum.
When a patient has surgically resectable mesothelioma, there is a good chance that they will get four cycles of neoadjuvant or adjuvant cisplatin-pemetrexed therapy.
In all, over the past couple of years, there has been more research done on mesothelioma in general as well as different approaches to new mesothelioma treatments that could be useful and could help prolong the lives of mesothelioma victims.
If you or a loved one has been diagnosed with mesothelioma or another asbestos-related disease, please call (800) 505-6000. We are here to provide you with information and legal help. To learn more, fill out our form.
Frequently Asked Questions
What is chromothripsis and how does it relate to mesothelioma?
Chromothripsis is a catastrophic genetic event in which thousands of chromosomal rearrangements occur simultaneously within a localized region of one or a few chromosomes — essentially, a chromosome “shatters” and reassembles incorrectly. Researchers have found that the BAP1 gene, which is the most commonly mutated gene in mesothelioma, is frequently affected by chromothripsis. In a study of 22 mesothelioma specimens, 1,535 chromosomal rearrangements were identified. Better understanding of this process could open the door to targeted genetic therapies for mesothelioma.
What is the BAP1 gene and why is it important in mesothelioma?
BAP1 is the gene most commonly mutated in mesothelioma patients. When functioning normally, BAP1 acts as a tumor suppressor — helping regulate cell growth and prevent cancer. When BAP1 is damaged or lost through chromothripsis or other mutations, this protective mechanism breaks down, allowing uncontrolled cell growth that can lead to mesothelioma. Researchers are studying BAP1 mutations as both a diagnostic marker (to help identify mesothelioma earlier) and a potential therapeutic target for new treatments.
What imaging tests are used to diagnose and plan treatment for mesothelioma?
Several imaging technologies are used at different stages:
- CT scan — the primary initial test, which can detect pleural thickening, pleural plaques, and pleural effusion
- Metabolic imaging (PET-CT) — used to determine the extent of the cancer and whether surgical removal may be possible
- MRI — used to examine the chest wall in detail
- Diffusion-weighted MRI — a newer technique being investigated to determine whether pleural disease is malignant or benign
These imaging tools help doctors decide which treatment approach — surgery, chemotherapy, radiation, or a combination — is most appropriate for each patient.
Why has pleurectomy decortication replaced extrapleural pneumonectomy as the preferred surgery?
Pleurectomy decortication (P/D) and extended P/D have largely replaced extrapleural pneumonectomy (EPP) because they are associated with lower mortality and morbidity rates. While EPP removes the entire affected lung along with portions of the diaphragm, chest lining, and heart membrane, P/D is a lung-sparing procedure that removes the diseased pleural lining and visible tumors while preserving the lung. Both aim for complete resection of visible cancer, but P/D carries lower surgical risk for most patients.
Why don’t all mesothelioma patients who are scheduled for surgery actually receive it?
Only 60% to 80% of patients who are planned for mesothelioma surgery actually undergo the procedure. The most common reason is that the patient’s physical condition at the time of surgery — assessed through performance status evaluations and pre-surgical testing — doesn’t meet the threshold for safely undergoing a major operation. Age, overall health, organ function, and disease progression between the time of scheduling and the surgery date can all contribute to a cancelled procedure.
How is radiation therapy used for mesothelioma?
Radiation therapy can be administered in several settings:
- Neoadjuvant — delivered before surgery to shrink tumors and improve surgical outcomes
- Adjuvant — delivered after surgery to target remaining cancer cells and reduce recurrence risk
- Palliative — used to manage symptoms like pain in patients with advanced disease
For early-stage pleural mesothelioma, radiation is typically directed at the hemithorax (the affected side of the chest) before or after surgery. Newer radiation methods are being developed to minimize damage to surrounding healthy tissue — a significant advancement given the proximity of the lungs to the heart and other vital organs.
What should I do if I’ve been diagnosed with mesothelioma?
If you or a loved one has been diagnosed with mesothelioma or another asbestos-related disease, understanding your treatment options — including emerging therapies — is a critical step. Call (800) 505-6000 or fill out our contact form for a free consultation and to request our Pennsylvania Mesothelioma Information Guide.
