Cancer Treatment Today » Mesothelioma

First line chemo for mesothelioma

M Levin, MD — Tue, 25 Sep 2012 17:53:49 +0000

For first line unresectable pleural mesothelioma, NCCN recommends: Alimta and carboplatin or cisplatin every 3 weeks as a Category 1 recommendation. In various studies, these combinations obtained overall response rate of 26.3% in 745 mesothelioma patients, and the combination of pemetrexed and carboplatin was associated with an overall response rate of 21.6%. One-year survival rate was 63 to 64%. The researchers’ findings were derived from an analysis of outcome data on 1,704 chemotherapy-naive patients.

If not these drugs, NCCN also advises gemcitabine/cisplatin or Alimta or vinorelbine as a single agent. The role of Avastin in mesothelioma is not defined and not well studied. It is in an ongoign French study: A Phase II-III Randomized Trial Pemetrexed-Cisplatin Chemotherapy With or Without Bevacizumab (Avastin), 15 mg/kg, for Malignant Pleural Mesothelioma (MPM), NCT00651456.

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Tazorac for CTCL – pro

M Levin, MD — Thu, 30 Aug 2012 18:12:10 +0000

CTCL includes a number of clinical syndromes, the most common of which are mycosis fungoides and the Sézary syndrome. Mycosis fungoides presents with patches, plaques, or tumors. In the initial stages disease is confined to the skin. Sézary syndrome is a leukemic variant of CTCL, characterized by erythroderma (stage T4), lymphadenopathy, pruritus and circulating neoplastic (Sézary) cells (stage B1).
Bexarotene is FDA approved for this disease whereas the very similar gel Tazoratene is not. The latter has only one study to support it. A 20 patient pilto study concluded that tazarotene 0.1% gel was a well-tolerated and effective adjuvant topical for the treatment of refractory MF lesions.
It is currenlty in a clinical trial: Tazarotene 0.1% Cream For the Treatment of Cutaneous T-Cell Lymphoma: A Prospective Study, NCT00779896 and despite the analogy with bexarotene is still experimental.

Whittaker SJ, Marsden JR, Spittle M, Russell Jones R. Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomas. Br J Dermatol 2003 Dec;149(6):1095-107. [67 references]

Apisarnthanarax N, Talpur R, Ward S, Ni X, Kim HW, Duvic M.
Tazarotene 0.1% gel for refractory mycosis fungoides lesions: an open-label pilot study.J Am Acad Dermatol. 2004 Apr;50(4):600-7.

Mesothelioma Surgery Options

M Levin, MD — Sun, 05 Aug 2012 15:20:28 +0000

Mesothelioma is a cancer that is most often linked to asbestos exposure. It can involve the lining of the lung (pleura) or of the belly (abdomen but are also found on the lining of the abdomen, heart or testicles. Pleural and abdominal mesotheliomas are the most common. Treating mesothelioma surgically remains difficult because it spreads along surfaces of these linings.

To perform surgery, accurate tumor staging is imperative since many patients in later stages of the disease are not candidates for some of the more radical approaches.

There are generally two surgical categories for the treatment and management of mesothelioma, cytoreductive (which aims to cure) and palliative (which aims to relieve symptoms).

Cytoreductive Surgery

Cytoreductive surgeries are radical and invasive techniques that focus on removing all of the cancer. These types of surgeries are only recommended for patients who are in good health and diagnosed with stage I or stage II mesothelioma. Some forward looking surgeons use the Sugarbaker technique which removes all cancer as well as the lining itself.

Extrapleural pneumonectomy (EPP) has been a standard treatment for pleural mesothelioma for many years. EPP involves the removal of the entire lung, diaphragm and pericardium. The diaphragm and pericardium are reconstructed synthetically after removal.

In studies so far, if aggressive surgery can be performed, five-year survival rates were as high was 46 percent.

Pleurectomy/Decortication (P/D) also involves surgically removing tumors. However, the lung is left mostly intact. Improved pulmonary function results in a lower mortality rate over EPP, but P/D has a slightly higher level of tumor recurrence. Postoperative radiation therapy is also limited because of the intact lung.

Both EPP and P/D are extremely invasive and the risk of morbidity and mortality are present for both procedures. Medical controversy still surrounds which procedure is more effective. More studies have yet to compare the effectiveness of these surgeries to systemic therapy and symptom control.

Palliative Surgery

Palliative surgery is a more conservative treatment. It focuses on the prevention and management of pleural effusion (fluid in the lining of the lungs) and tumor debulking to relieve chest pain and allow lung expansion. Debulking means removing the bulk of the cancer, but not to attempt to remove it all. For patients in later stages of the disease, palliative treatment offers relief from symptoms and prolonged survival.

Other procedures such as pleurodesis can relieve symptoms by surgically inserting a talc mixture to close the pleural space and remove the place where fluid can accumulate. A permanent chest drain can also be inserted to prevent the build-up of fluid.

Though surgery remains an option for the treatment of mesothelioma, many experts advocate an aggressive multimodal approach that uses chemotherapy and radiation together with surgery, in an attempt to improve on long term results.

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