Dr. Cameron advocates a multimodal treatment approach for malignant pleural mesothelioma: Surgery, Chemotherapy, and Radiation to treat Malignant Pleural Mesothelioma

Since 2004, The combination of two FDA approved chemotherapy drugs, Pemetrexed (brand name: Alimta) and Cisplatin (no brand name) have been aggressively marketed as the “standard treatment” for malignant pleural mesothelioma.

HOWEVER,

Dr. Robert Cameron advocates a multimodal treatment approach for patients deemed eligible for surgery, consisting of: SURGERY, CHEMOTHERAPY, AND RADIATION

WHY?

• Published data show that the combination of surgery, radiation, and chemotherapy is almost always associated with the longest survival times for pleural mesothelioma patients who are eligible for surgery. The median survival of patients who receive multimodal therapy varies from 16 to 22 months, depending on the staging, type of surgery, cell type, as well as other factors.
• Surgery can remove gross mesothelioma tumor in up to 85% of patients (equivalent to a complete pathological response which is rare with cisplatin and pemetrexed. Adjuvant therapies, including chemotherapy and radiation can then be used to maintain a clinical remission. Furthermore, maintenance therapies, that can continue to suppress microscopic disease and forestall the tumor’s recurrence, as advocated by a few may provide even more long-term benefit.
• Treating and managing mesothelioma as a chronic illness acknowledges the refractory (resistant to treatment) nature of the disease to all therapies and focuses on coping rather than curing.
• Chemotherapy is an important weapon in the treatment of malignant pleural mesothelioma. However, in patients who are otherwise eligible for surgery, it is probably best used in a well planned multimodality therapy regimen.  Medical oncologists should advise their mesothelioma patients to consult with thoracic surgeons who have expertise in mesothelioma surgery, just as surgeons should advise their patients to consult with a qualified medical oncologist about the potential benefits of adjuvant (additional) chemotherapy and radiation. Patients who are evaluated and treated in a defined multimodality therapy regimen by a multidisciplinary team of physicians, including surgeons, medical oncologists, and radiation oncologists generally will be the most optimally managed and best served by their physicians. 

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