There is currently no cure for mesothelioma.
Mesothelioma research focuses on improved diagnostic tools for early detection.
More effective treatment techniques for mesothelioma are constantly being researched.
Emerging treatments through clinical trials offer hope towards finding a cure.
Mesothelioma is a rare cancer with an average life expectancy of 12 – 21 months, largely because of difficulties in early detection and often limited treatment options. Mesothelioma researchers continue to look for a cure, while also developing enhanced diagnostic tools and treatment techniques through clinical trials to improve survival and overall quality of life. In recent years, researchers have seen promising results from various treatments like immunotherapy, as well as diagnostic methods like new biomarkers.
One of the best ways to improve mesothelioma prognosis is through early detection. Patients diagnosed at stage 1 or stage 2 have the most treatment options, likely able to undergo aggressive surgeries to remove as much of the cancer as possible. However, recognizing the disease early can be difficult. Symptoms can take 10 – 50 years to develop after asbestos exposure, and in many cases, individuals may not know that they were exposed in the first place.
Currently, the only way to definitively diagnose a patient with mesothelioma is through a biopsy. However, mesothelioma cancer research continues to find promising methods that may be able to help diagnose the cancer earlier.
Mesothelioma Blood Tests and Biomarkers
Blood tests and biomarkers in particular offer hope, allowing mesothelioma specialists to detect certain substances in the blood that reveal a history of asbestos exposure, show mesothelioma symptoms or suggest that a patient does have mesothelioma. A blood test could encourage physicians to conduct imaging scans or biopsies sooner, improving the likelihood that the patient will be diagnosed in the early stages.
HMGB1 is one biomarker in particular that has shown success in helping diagnose lung cancer and pleural mesothelioma patients. In one recent study, HMGB1 was able to differentiate between patients with malignant mesothelioma and those with a history of asbestos exposure, but no cancer with a sensitivity of 100%.
Other Emerging Diagnostic Tools
In addition to researching mesothelioma biomarkers for early detection, other diagnostic tools have emerged that are worthy of additional research. Many of these options are still in the very early stages, but offer hope towards expanding the ways that mesothelioma and other aggressive malignancies can be diagnosed.
The mesothelioma breath test uses breathomics to detect breath-volatile organic compounds (BVOCs) in the exhaled breath, which are sometimes present in patients with certain malignancies. BVOCs can act like a fingerprint for certain diseases, providing physicians with a quick, non-invasive alternative to understanding the potential cause of patient symptoms. Studies have shown some success in detecting malignant pleural mesothelioma with a breath test, but more research is needed.
Another recent study has focused on the behavior of cancer cells when patient DNA is dropped into a mixture of water and gold particles. When DNA was placed in water, the study found that healthy DNA maintained its structure, while cancerous DNA folded. Malignant DNA also showed an affinity to gold particles, sticking to the particles after folding and creating visible color changes to the water in less than five minutes. Like the mesothelioma breath test, this method also requires further research and testing through clinical trials.
Treatments for Mesothelioma
Multimodal treatment is the most common approach for cancer patients with malignant mesothelioma, incorporating surgery, chemotherapy and/or radiation therapy. In efforts to find a way to cure mesothelioma, researchers are constantly looking into new surgery methods, chemotherapy drugs and radiation techniques to find the most effective options. Many mesothelioma clinical trials have also focused on combinations of standard cancer treatments and how they affect patient prognosis.
Some treatment combinations have shown particular success in recent studies, such as cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma. For surgery and HIPEC treatments, the patient typically first undergoes surgery to remove as much of the mesothelioma cancer as possible. A heated chemotherapy wash is then circulated through the peritoneal cavity to kill any remaining cancer cells, while also helping prevent recurrence, which is common for mesothelioma.
HIPEC has shown much success in cure and treatment research, with researchers now also exploring a similar approach for patients with pleural mesothelioma. In one study of 108 patients with malignant peritoneal mesothelioma, 43.6% of patients who underwent complete cytoreduction (surgical removal of their mesothelioma tumors) with HIPEC were considered cured with survival of seven years or longer. However, they did note that survival and surgical outcomes can vary based on the type of mesothelioma, stage and other patient characteristics.
Other Emerging Mesothelioma Treatments
- Cryotherapy: Patients are subject to extreme cold to freeze and kill malignant mesothelioma cells.
- Epigenetic therapy: Focuses on altering gene expression to stop cancer growth.
- Gene therapy: Attempts to replace or repair missing or corrupt genes from cancer mutations.
- Immunotherapy: Immunotherapy drugs bolster the body’s immune system to fight cancer cells.
- Photodynamic therapy: Uses light and photosynthesizing agents to target and kill cancer cells with minimal damage to healthy cells.
Although immunotherapy is still considered an emerging treatment for mesothelioma, it continues to grow in success and is becoming more widely available to patients. Immunotherapy treatments were previously only available through clinical trials, but are now being offered to more patients if recommended by their physician.
One of the most common immunotherapy drugs is the checkpoint inhibitor Keytruda, also known as pembrolizumab. In one clinical study, 56% of patients using Keytruda experienced a reduction in tumor size. There was an average overall survival of 18 months and patients were able to see six months with no disease progression. A recent study focusing on newer successes of immunotherapy found a 2-year survival rate with 36% of malignant mesothelioma patients treated with tremelimumab, an immune checkpoint inhibitor, in addition to low toxicity and an overall positive response to the treatment. Pembrolizumab allowed 52% of patients in the study to achieve stable disease with 5.4 months of progression-free survival and median overall survival of 18 months. While immunotherapy hasn’t yet been able to cure mesothelioma, it has been able to stop or slow disease progression, while extending survival for many patients.
Finding a Mesothelioma Cure
There are many groups dedicated specifically to mesothelioma research, such as the International Mesothelioma Interest Group and International Mesothelioma Program. Researchers have been looking for a cure since the mid-1900s when the first cases of mesothelioma began to emerge. Although there is no cure for mesothelioma, there has been an extensive history of mesothelioma research, contributing to the evolving treatment methods that are used today to improve patient survival.
History of Finding a Cure for Mesothelioma
- Early 1900s: Mesothelioma was an unknown disease
- 1920: The term “mesothelioma” was first used, but not yet linked to asbestos exposure.
- Early to mid-1900s: Physician-scientists began carefully studying the disease, looking for curative treatments.
- Early 1940s: Specialists began treating pleural mesothelioma by removing the entire affected lung and pleura. From the 1940s to now, physicians have developed non-invasive, lung-sparing surgical options.
- Early 2000s: Radiation and chemotherapy became standard mesothelioma treatment options.
- 2004: The United States Food and Drug Administration (FDA) approved the drug Alimta (pemetrexed) for use in combination with cisplatin for patients with malignant pleural mesothelioma. It was the first drug to receive FDA approval for mesothelioma, and the combination of pemetrexed and cisplatin is considered the gold standard chemotherapy for mesothelioma.
Current Research Efforts
Before new treatments are available to all mesothelioma patients, they are first tested through clinical trials. Today, hundreds of clinical trials are being conducted at cancer centers around the United States with a focus on malignant mesothelioma. Researchers measure success rates to determine what methods are the most effective at extending survival, while also collecting data on mesothelioma type, stage of cancer, cell type, patient characteristics and other factors in an effort to understand the disease. Clinical trials also collect information on potential treatment side effects of new drugs to help physicians and patients determine what treatment option is best for their case, while maintaining a high quality of life.
Most success surrounds malignant pleural mesothelioma and malignant peritoneal mesothelioma, the most common types of the cancer, with peritoneal showing the greatest improvement because of treatment advancements like HIPEC. Studies have shown that part of these successes in improving mesothelioma survival rates is due to diagnosing patients at a younger age, while their cancer is still in its earlier stages, stressing the importance of enhanced diagnostic techniques.
Over the years, studies have shown that mesothelioma survival rates continue to improve. There are numerous studies, such as with immunotherapy, documenting reduction in tumor size, improvement of symptoms, progression-free survival and extended life expectancies. Immunotherapy, once only available through clinical trials has emerged as a successful option for patients not undergoing experimental treatments. Many patients have been able to achieve remission. As numerous studies emerge each year, there is more hope for the mesothelioma community for one day finding a cure.