Dealing with Recurrent Mesothelioma

Mesothelioma can be benign but the majority of time it is malignant.  The benign form of mesothelioma is often very treatable with surgery. Malignant mesothelioma, on the other hand, is often very difficult to treat and has a poor prognosis for patients.  This is largely due to the fact that the cancer is well advanced before it is diagnosed. Regardless of whether the initial mesothelioma is benign or malignant, there is a chance of the disease returning after a successful treatment.  When it returns, it is known as recurrent mesothelioma.

With benign mesothelioma, there is a low chance of recurrence – just about 10%. If the mesothelioma does return, it can often be treated again with surgery alone.  With malignant mesothelioma, there is a high likelihood of recurrence after treatment.  The mesothelioma may reappear in the same initial location, or the cancer may metastasize to other areas of the body.

Treatment is Determined Case-By-Case

There is no standard procedure for treating recurrent malignant mesothelioma.  Each case is different, and the doctor must assess your particular condition to decide on the right treatment, if any treatment is possible. The course of treatment will vary depending on the type, location, and severity of the recurring mesothelioma as will consider the treatment which was initially used.

Treatment options chosen for recurrent mesothelioma are usually more aggressive than the initial approach or often involve a different method or approach.  For patients who were initially treated with surgery, chemotherapy may be the recommended course of treatment. For patients who initially received chemotherapy, the recurrent mesothelioma may be treated with a combination of chemotherapy agents.

Recurrent mesothelioma has a very poor prognosis because it indicates that the cancer is advancing and was not destroyed with the first treatment. However, medical research continues to pursue new types of drugs that will delay the advance of malignancies when the drugs are used as secondary treatments when mesothelioma recurs. The studies test new chemotherapy drugs and measure:1

  • Drug therapy response rate
  • Survival time during which the disease does not progress
  • Progression of recurring tumors
  • Time it takes for treatment to fail
  • Toxicity

One of the more recent research advances was the approval of the chemotherapy drug Pemetrexed which is now being tested as a treatment in combination with the chemotherapy cisplatin drug  to treat malignant pleural mesothelioma. This therapy is a second line treatment meaning patients have already received chemotherapy once before.2 There is no doubt that ongoing research will continue to develop new drug therapies, and perhaps one day mesothelioma will be able to be treated with greater success.

Are Clinical Trials for You?

Patients who have been diagnosed with recurrent mesothelioma may be eligible to take part in clinical trials which test new methods of treating malignant mesothelioma.  These trials may one day help researchers find a cure for mesothelioma. The National Cancer Institute maintains a list of current clinical trials focused on recurrent malignant mesothelioma.3  Clinical trials offer treatments not yet approved by the Food and Drug Administration and may include:

  • New chemotherapy agents or a new mixture of chemotherapy drugs
  • New biologicals
  • Physical approaches using technology or surgery

Researchers conducting the trials will perform many tests throughout the trials that are intended to document tissue histology, assess therapy responses, identify physical responses during and after treatments in comparison to pre-treatment condition and many other treatment features.

However, the methods used in the trials may not always be effective. It is important to understand that these clinical trials are testing new methods and drugs that have no long term record of results documented. In some cases, the patients take a turn for the worse because the new treatment fails, the treatment makes them sicker or they are selected to participate in the “blind” group meaning they are given placebos.

You should always make sure you fully understand the possible risks and rewards of the specific clinical trial before agreeing to participate. In some cases, the malignancy has advanced to the point where the patient agrees to the trial only to help those mesothelioma victims who will survive him or her. In other cases, there is true hope that the new treatment will improve the prognosis and extend life with as much quality as possible. Still others are willing to take any risk in the hope the new treatment will lead to a research breakthrough.

The type of clinical trial you are eligible for will depend on the prior treatments you have received for mesothelioma, the type of mesothelioma you have been diagnosed with and the stage of the mesothelioma. You should evaluate your reasons for agreeing to participate clinical trials closely.

References

1 Jassem J, Ramlau R, Santoro A, et al.: Phase III trial of pemetrexed plus best supportive care compared with best supportive care in previously treated patients with advanced malignant pleural mesothelioma. J Clin Oncol 26 (10): 1698-704, 2008.  [PUBMED Abstract]

2 Pemetrexed. (2006) Retrieved from Pemetrexed Information at www.pemetrexed.org/.

3 Recurrent Malignant Mesothelioma (n.d.) Retrieved from the National Cancer Institute at:  www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/HealthProfessional/page7