During the National Comprehensive Cancer Network’s (NCCN) 15th Annual Conference, guidelines concerning treatment for malignant pleural mesothelioma were presented. Lee M. Krug, a doctor at Memorial Sloan-Kettering Cancer Center and a member of the NCCN Guidelines Panel, spoke about recommended treatment options for mesothelioma patients.
Malignant mesothelioma is a rare form of cancer almost exclusively caused by asbestos exposure. Symptoms can take as long as 20 to 50 years to arise once someone has been exposed and this often results in a late diagnosis for patients. Approximately 2,000 to 3,000 people are diagnosed with mesothelioma cancer in the United States each year.
According to Dr. Krug, “Diagnosing mesothelioma is often difficult because the symptoms are similar to those of a number of other conditions. In addition, a physician’s initial evaluation of a patient may reveal pleural effusion, but it can often be missed on pleural fluid cytology.”
Pleural mesothelioma symptoms typically include shortness of breath or chest pain. Other symptoms patients may experience include fevers, weight loss, fatigue and coughing up blood. Dr. Krug also noted that surgical biopsies are often required to effectively diagnose mesothelioma.
Treatment for pleural mesothelioma may depend on several factors, including the stage of the cancer, its location, and whether or not the cancer has metastasized to other areas in the body. Dr. Krug listed treatments such as surgery, chemotherapy and radiation that are beneficial to patients and recommended by the NCCN Guidelines.
A common surgical procedure for pleural mesothelioma patients is an extrapleural pneumonectomy. This procedure removes the pleura, affected lung, diaphragm and part of the pericardium. However, this surgery should only be performed by experienced surgeons and for those diagnosed in the early stages of mesothelioma development.
Dr. Krug stated, “The role of aggressive surgery remains controversial. As outlined in the Principles for Surgical Resection for Malignant Pleural mesothelioma in the NCCN Guidelines, physicians need to be highly selective when choosing potential candidates for this procedure.”
The NCCN Guidelines recommend a combined modality therapy approach for certain patients, which utilizes the effects of surgery, radiation and chemotherapy. Radiation can sometimes be used after surgery to help with local control and to provide relief from chest pain and other symptoms. Chemotherapy may also benefit patients and can be used before or after surgery.
According to the NCCN Guidelines, pemetrexed (Alimta) combined with cisplatin is the optimal first-line combination chemotherapy regimen for mesothelioma patients.
The NCCN is an alliance of 21 of the world’s leading cancer centers. According the organization’s Web site, the primary goal of all NCCN initiatives is to improve the quality, effectiveness and efficiency of oncology practice so patients can live better lives.
Additional information about mesothelioma may be found through the mesothelioma Center.