agus or possibly the ribs on the same side of the body as the original pleural malignancy. There may or may not be lymph node involvement.
Stage IV: Mesothelioma has moved to the opposite side of the body, impacting the pleura on the other lung as well as the opposite lung itself, and possibly extending to organs in the abdominal cavity. Metastases have occurred in several areas.
Malignant Mesothelioma Prognosis
Surgery to resect malignant tissue is generally a viable choice with stages one and two, and often with stage three. In the latter case, it depends on the location of the extended malignancy. In stage two and stage three cases, the surgery may involve only a partial removal of malignant tissue, a process referred to as "debulking." In all cases, a regimen of chemotherapy and usually radiotherapy follows the surgical procedure.
In cases where surgery has been performed and an aggressive chemotherapy program undertaken, the prognosis for mesothelioma patients who are otherwise healthy patients may extend to eighteen months or beyond. If the cancer was at stage one or stage two, the outlook for a reasonable survival period can be encouraging. Unfortunately, the median survival period for mesothelioma patients in general hovers at around one year. Some studies have shown the figure to be thirteen months; others closer to eleven months or less. But the value of a surgical intervention followed by chemotherapy seems to be well established; while most gains are in months some are in years.
Mesothelioma Clinical Trials
There is an excellent database of current clinical trials underway for mesothelioma treatment at the National Institutes of Health (NIH) website ClinicalTrials.gov. Most of them evolve around the use of various chemotherapy drugs in combination with one another. The two drugs that have proven to impact mesothelioma tumors with some success are pemetrexed and cisplatin; these are the only two approved by the FDA for mesothelioma treatment.
The drugs are effective against some forms of mesothelioma malignant cells and less so against others; effective with pleural mesothelioma, perhaps, but ineffective with the pericardium. The point is that these two drugs have proven the ability to successfully kill some of the cancer cells some of the time and so many of the clinical trials involve using other cancer chemotherapy drugs in conjunction with pemetrexed, cisplatin, or both.
All of the chemotherapy drugs used in mesothelioma clinical trials such as these have been approved for treatment of other types of tumors. For example some drugs such as Bortezomib act by stopping blood flow to a tumor, and by killing certain enzymes that allow malignant cells to proliferate. There is currently a clinical study using this drug in conjunction with cisplatin to test the success with malignant mesothelioma tumors.
Onconase is a drug that impacts the RNA in some cancer cells, causing them to die. Clinical trials using this chemotherapy drug in conjunction with other drugs that starve tumors by choking off blood supply or that somehow suppress the ability of malignant cells to multiply are underway in several locations. Some of these trials are sponsored by the National Cancer Institute, some are generated in foreign medical centers, and some are undertaken by cancer centers in the U.S. with the assistance of grants from the NIH.
There are also trials underway attempting to establish effective methods of using photodynamic therapy to target diseased cells, along with other methods that are meant to protect the healthy cells surrounding tumors. Destroying healthy cells has always been an issue with chemotherapy and radiotherapy; today researchers are using new technology and molecular knowledge to try and find healthier ways to treat post-operative malignant mesothelioma.
- Localized Benign Pleural Mesothelioma, Altin, et al, Zonguldak Karaelmas University, Department of Pulmonology, Turkey, 2003
- Detailed Guide: Malignant Mesothelioma, American Cancer Society, http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_malig