1
Guidance
1.1
Pemetrexed is recommended as a treatment option for malignant pleural mesothelioma only in people who have a World Health Organization (WHO) performance status of 0 or 1, who are considered to have advanced disease and for whom surgical resection is considered inappropriate.
1.2
Patients currently receiving pemetrexed who do not fall into the patient population defined in section 1.1 should have the option to continue therapy until they and their clinicians consider it appropriate to stop.
2
Clinical need and practice
2.1
Malignant pleural mesothelioma (MPM) is a type of cancer that occurs in the pleura – the mesothelium (membranous lining) surrounding the lungs. MPM is a rapidly progressive malignancy of insidious onset.
2.2
Approximately 90% of cases of MPM are linked to asbestos exposure. When asbestos fibres are inhaled or swallowed, they can cause scarring of the lung tissues, cancer of the bronchial tree (lung cancer) and sometimes cancers in the pleura and peritoneum. A wide range of occupations, notably shipbuilding, railway engineering and asbestos product manufacture, are associated with an increased risk of MPM. Family members of people whose work clothes were contaminated with asbestos fibres have also developed MPM. The condition is significantly more common in men, with a male to female ratio of 5:1. People with mesothelioma usually present with the disease between the ages of 60 and 79 years.
2.3
MPM usually develops 20–50 years after exposure to asbestos. Data from 2004 suggest that about 1700 people in the UK are diagnosed with MPM each year. It is estimated that this figure will increase to a peak of more than 2000 cases each year between 2011 and 2015, reflecting a lag from the highest use of asbestos in the 1970s. An estimated 65,000 cases are
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expected to occur between 2002 and 2050. The use of asbestos was banned in the UK in 1999.
2.4
Most people with MPM present with chest pain and dyspnoea and have pleural effusions evident on examination. Fatigue, profuse sweating, weight loss, anorexia and difficulty in swallowing become common as the disease progresses. Presentation and diagnosis often occur at an advanced stage and the prognosis for most patients is extremely poor. Median survival from diagnosis varies in studies, with a range of 9–13 months. Age, tumour histology, tumour stage at diagnosis and performance status have been shown to be independent prognostic factors. The most commonly used performance status scoring systems include the Karnofsky performance status (KPS) and the World Health Organization (WHO) scales. KPS is a 10-point scale ranging from 0 to 100, with higher scores representing normal day-to-day activity. The WHO system is a five-point scale with lower scores representing normal day-to-day activity. In general, WHO scores of 0 and 1 are considered equivalent to KPS scores of 70–100.
2.5
There is no standard treatment pathway for MPM in England and Wales. The clinical management is multimodal and a patient may receive a combination of treatments. Staging provides prognostic information and can help to determine an appropriate treatment strategy; however, it is complex, and surgical intervention is required to stage the disease fully. There is no universally accepted staging system, but the traditional Butchart system is gradually being replaced with a tumour nodes metastases (TNM) system developed by the International Mesothelioma Interest Group. In clinical practice, MPM is generally staged pragmatically based on whether or not surgical resection is considered an appropriate option. Extrapleural pneumonectomy is an option for the small proportion of patients (1–5%) whose tumours are at stage 1 or 2.
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2.6
Surgery is not indicated for the majority of patients, so treatment aims to improve symptoms and maintain quality of life for as long as possible. Often, this does not involve treating the tumour with chemotherapy. Treatment that does not include a specific anti-cancer therapy is referred to as active symptom control (ASC) or best supportive care (BSC). For people with MPM, this may include interventions to manage pain and dyspnoea, and to address psychosocial problems. Treatments may include draining excess fluid from the pleural cavity and applying a talc pleurodesis (the insertion of talc to prevent further fluid accumulation), palliative radiotherapy, analgesics, steroids, appetite stimulants and bronchodilators.
2.7
There is no standard chemotherapy treatment for MPM. Pemetrexed in combination with cisplatin is the only chemotherapy regimen that is currently licensed for this indication. However, a variety of combination and single-agent regimens such as the mitomycin C, vinblastine and cisplatin combination (MVP) or vinorelbine are used. To date there have been no published randomised controlled trials (RCTs) comparing survival and symptom control in patients receiving chemotherapy with those receiving ASC.
3
The technology
3.1
Pemetrexed (Alimta, Eli Lilly and Company) is licensed, in combination with cisplatin, for the treatment of chemotherapy-naive patients with unresectable MPM. Pemetrexed is a multi-targeted folate antagonist that inhibits DNA replication. Cisplatin is a platinum-based chemotherapeutic agent that has anti-tumour activity, either as a single agent or in combination, for a number of different cancers. The licensed dose of pemetrexed is 500 mg/m2 body surface area, to be administered as a 10-minute intravenous infusion on the first day of a 21-day cycle. It is followed approximately 30 minutes later by cisplatin (recommended dose 75 mg/m2 body surface area) infused over 2 hours. In order to reduce toxicity, patients treated with pemetrexed must receive folic acid and vitamin B12 supplementation. To reduce the incidence
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and severity of skin reactions, patients are pre-medicated with a corticosteroid.
3.2
Adverse effects commonly associated with pemetrexed include nausea, vomiting, fatigue and neutropenia. Skin rash, mucositis and liver function abnormalities have also been reported. Cisplatin causes nausea and vomiting in the majority of patients. This is controllable in 50–80% of patients with anti-emetic drugs. Serious toxic effects of cisplatin on the kidneys, bone marrow and ears are common, and serum electrolyte disturbances, hyperuricaemia, allergic reactions and cardiac abnormalities have also been reported. For full details of side effects and contraindications, see the summaries of product characteristics.
3.3
Pemetrexed costs £800 for a 500-mg vial (excluding VAT, ‘British national formulary’ [BNF] 53rd edition). The cost per patient, assuming an average of five treatment cycles and a body surface area of 1.8 m2, is approximately £8000. Costs may vary in different settings because of negotiated procurement discounts.
4
Evidence and interpretation
The Appraisal Committee (appendix A) considered evidence from a number of sources (appendix B).
4.1
Clinical effectiveness
4.1.1
A single RCT of pemetrexed in MPM was identified. The EMPHACIS (‘Evaluation of mesothelioma in a Phase III trial of pemetrexed with cisplatin’) study compared pemetrexed plus cisplatin with cisplatin alone. This was a single-blind, international, multicentre trial in 448 patients. To be eligible, patients had to be 18 years or older, and were required to have a minimum life expectancy of 12 weeks, uni- or bi-dimensionally measurable disease, and a KPS of greater than or equal to 70. Patients who had had prior chemotherapy, those with a second primary malignancy or brain metastasis,
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and those unable to interrupt non-steroidal anti-inflammatory drugs were excluded.
4.1.2
Patients in the intervention arm (n = 226) received pemetrexed at a dose of 500 mg/m2 followed 30 minutes later by cisplatin at a dose of 75 mg/m2. Patients in the control arm (n = 222) received normal saline followed 30 minutes later by cisplatin at a dose of 75 mg/m2. In both arms, treatment was administered on the first day of each 21-day cycle. The median number of cycles given was 6 (range 1–12) in the pemetrexed plus cisplatin arm and 4 (range 1–9) in the cisplatin arm. Median length of follow-up was 10 months.
4.1.3
During the early stages of the trial, incidences of severe toxicity (including drug-related death, neutropenia, febrile neutropenia and diarrhoea) were high in the combination arm. Folic acid and vitamin B12 supplementation were therefore added to the trial protocol in both treatment arms to preserve blinding. With effect from the date of the protocol change, all patients received supplementation, resulting in three patient subgroups defined by supplementation status: never supplemented (n = 70), partially supplemented (those who started treatment before the protocol change; n = 47) and fully supplemented (those who started treatment after the protocol change; n = 331). The primary analysis was performed on all patients who were randomised and treated (intention-to-treat [ITT] population). A subgroup analysis was performed on fully supplemented patients. Further post-hoc subgroup analyses were performed on fully supplemented patients with advanced disease (stage 3/4) because it was thought that most patients presenting to clinicians would fall into this category.
4.1.4
The primary endpoint of the EMPHACIS trial was survival. A statistically significant survival benefit was observed in patients randomised to pemetrexed plus cisplatin versus those receiving cisplatin alone. In the ITT population, median survival was 12.1 months (95% confidence interval [CI], 10.0 to 14.4) in the pemetrexed plus cisplatin arm versus 9.3 months (95% CI, 7.8 to 10.7) in the cisplatin arm (hazard ratio [HR] 0.77; 95% CI, 0.61 to 0.96;
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log rank test p value = 0.02). In fully supplemented patients, median survival was 13.3 months (95% CI, 11.4 to 14.9) in the combination arm versus 10 months (95% CI, 8.4 to 11.9) in the cisplatin arm (HR 0.75; 95% CI, 0.57 to 1.00; log-rank test p value = 0.051). In fully supplemented patients with advanced disease, median survival was 13.2 months (95% CI, 9.3 to 14.9) in the combination arm versus 8.4 months (95% CI, 6.8 to 10.2) in the cisplatin arm (HR 0.63; 95% CI, 0.46 to 0.86; log rank test p value = 0.003).
4.1.5
Secondary endpoints included 1-year survival, median time to progressive disease and tumour response rate. Pemetrexed plus cisplatin demonstrated statistically significant benefits versus cisplatin alone for all of these outcomes in the ITT population and in the subgroups. The results for these endpoints in the ITT population for the pemetrexed plus cisplatin group versus the cisplatin alone group, respectively, were as follows:
•
1-year survival: 50.3% versus 38.0% (p = 0.012)
•
median time to progression: 5.7 months versus 3.9 months (p < 0.001)
•
tumour response rate: 41.3% versus 16.7% (p < 0.001).
4.1.6
Quality of life was evaluated using the Lung Cancer Symptom Scale–Meso instrument. Several aspects of quality of life were evaluated, including pain, dyspnoea, fatigue, anorexia and cough. Over 18 weeks, patients treated with pemetrexed plus cisplatin demonstrated statistically significant symptomatic improvements when compared with those who received cisplatin alone. For global quality of life in the ITT population, a least squares mean score of 56 out of 100 was reported for patients randomised to pemetrexed plus cisplatin versus a score of 53 out of 100 for patients in the cisplatin arm (p value for the difference between arms = 0.012). A similar result was observed in the fully supplemented population.
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4.1.7
Severe to life-threatening or disabling adverse events were statistically significantly more frequent in patients receiving pemetrexed plus cisplatin than in those receiving cisplatin alone. The most commonly reported of these in patients receiving pemetrexed plus cisplatin were: neutropenia (27.9%), leukopenia (17.7%), nausea (14.6%) and vomiting (13.3%). Supplementation with folic acid and vitamin B12 resulted in a consistent reduction in the severity and incidence of adverse events (except for dehydration) in the pemetrexed plus cisplatin arm. The most common severe adverse events in fully supplemented patients randomised to pemetrexed plus cisplatin were: neutropenia (23.2%), leukopenia (14.9%), nausea (11.9%) and vomiting (10.7%).
4.1.8
Supplementary documentation on pemetrexed provided by the manufacturer indicated that, in the ITT population, 42% (94 of 226) of patients randomised to pemetrexed plus cisplatin responded to treatment. Of those who experienced a response, 87% (82 of 94) did so within four cycles.
Summary of the evidence on clinical effectiveness
4.1.9
The results of the EMPHACIS trial suggest that pemetrexed plus cisplatin confers a survival benefit of approximately 3 months compared with cisplatin alone. The combination treatment also appears to demonstrate advantages in terms of 1-year survival, median time to progressive disease, tumour response rate and quality of life. Pemetrexed plus cisplatin appears to offer greater survival benefits than cisplatin alone in patients with advanced disease.
4.2
Cost effectiveness
4.2.1
Estimates of cost effectiveness were provided by the manufacturer and by the Assessment Group. A review of the published literature identified a single cost-effectiveness study. This was a conference presentation/abstract that was a forerunner of the manufacturer’s submission.
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4.2.2
Two cost-effectiveness models were submitted by the manufacturer. Model 1 compared pemetrexed plus cisplatin with cisplatin alone. Model 2 compared pemetrexed plus cisplatin with standard care (as defined by the manufacturer on the basis of a market research survey). Both models had a 29-month time horizon (reflecting the trial follow-up period) and took a health service perspective. Both considered outcomes in terms of life years gained and quality-adjusted life years (QALYs). No discounting was applied to costs, because they were all incurred within 1 year. Outcomes were discounted at 3.5%.
4.2.3
Model 1 was based on individual patient data from the EMPHACIS trial. The model considered four subgroups: fully supplemented patients; fully supplemented patients with advanced disease; fully supplemented patients with good performance status (WHO performance status of 0 or 1); and fully supplemented patients with advanced disease and good performance status. Data for resource use were taken from the trial and unit costs were taken from Department of Health reference costs or official drug price lists (BNF, MIMS 2005). Mean survival was estimated from the trial data using Kaplan-Meier curves. Utility scores were taken from an ongoing observational study in patients with non-small-cell lung cancer (NSCLC) who completed the EQ-5D health-related quality of life questionnaire before chemotherapy. The base-case utility scores in both economic models were similar for both arms (0.68 for the pemetrexed plus cisplatin arm and 0.69 for the cisplatin alone arm) and did not take account of loss of quality of life in people with MPM as their disease progresses. A range of one-way and two-way sensitivity analyses was performed. No probabilistic sensitivity analysis was performed.
4.2.4
The incremental cost-effectiveness ratio (ICER) was £68,598 per QALY gained in the fully supplemented population. The ICER was more favourable in fully supplemented patients with advanced disease (£53,314 per QALY gained), fully supplemented patients with good performance status (£48,099
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per QALY gained), and fully supplemented patients with advanced disease and good performance status (£47,567 per QALY gained).
4.2.5
Model 2 indirectly compared pemetrexed plus cisplatin with MVP, vinorelbine (with or without platinum) and ASC. Costs and outcomes for pemetrexed plus cisplatin were taken from the fully supplemented population in model 1. For the comparators, resource use data were gathered from market research surveys of oncologists, commissioned by the manufacturer. Zero cost was assumed for ASC, because it was reasoned that participants in chemotherapy trials would have received a similar level of ASC to patients receiving ASC alone. Median survival estimates were taken from a review of the published literature. Mean values for use in the cost-effectiveness analysis were derived by calculating a weighted average of reported medians and assuming the same mean to median ratio as that observed in the cisplatin only arm of the EMPHACIS trial. The same utility values were used as in model 1, with the utility for cisplatin (0.69) being applied to all comparators in model 2. A range of one-way and two-way sensitivity analyses was performed. The incremental cost per QALY gained for pemetrexed plus cisplatin was calculated to be £21,731 versus MVP, £28,391 versus vinorelbine with or without platinum and £32,066 versus ASC.
4.2.6
When the Assessment Group corrected the survival estimate for MVP for performance status, an ICER of £47,972 per QALY gained was obtained for pemetrexed plus cisplatin versus MVP. Using more favourable survival estimates and taking the number of cycles of chemotherapy from the literature rather than the manufacturer’s market research survey, the ICERs versus MVP and vinorelbine were both above £60,000 per QALY gained. Using survival estimates for ASC taken from a meta-analysis designed to consider prognostic factors in MPM resulted in an ICER of £48,779 per QALY gained for pemetrexed plus cisplatin versus ASC.
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4.2.7
The Assessment Group also carried out its own economic analysis of pemetrexed plus cisplatin compared with cisplatin alone. The four subgroups considered in the manufacturer’s model 1 were analysed. Mean costs were derived from the individual patient data in model 1. Costs were not discounted. To derive mean effectiveness estimates, Weibull distributions were fitted to the Kaplan-Meier survival curves from the EMPHACIS trial, in order to model the survival distribution of patients at the end of the follow-up period. Mean survival was estimated using the weighted least squares method and a discount rate of 3.5% was applied. In both arms, the Assessment Group used mean utility values of 0.51–0.54 for each subgroup. These values were calculated using an initial utility of 0.65, falling to 0.40 during a 100-day terminal period to account for lower quality of life in people with MPM towards the end of their life.
4.2.8
The Assessment Group’s analysis resulted in an ICER of £60,600 per QALY gained in the fully supplemented population. The results were more favourable in fully supplemented patients with advanced disease (£49,100 per QALY gained), fully supplemented patients with good performance status (£50,400 per QALY gained) and fully supplemented patients with advanced disease and good performance status (£37,700 per QALY gained). The Assessment Group also calculated the cost effectiveness of pemetrexed plus cisplatin versus cisplatin alone in fully supplemented patients with advanced disease and good performance status under the assumption that a smaller 100-mg vial of pemetrexed becomes available. In this case the ICER was £34,500 per QALY gained.
4.2.9
In a later document, the manufacturer suggested that the ICERs for pemetrexed plus cisplatin might be lower if treatment was stopped in patients who did not experience a tumour response after their fourth cycle. It was suggested that this would lower overall costs without reducing aggregate health benefit, because only those who respond to treatment would
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experience survival gains. No clinical evidence or economic analysis to support this proposal was submitted.
Summary of the evidence on cost effectiveness
4.2.10
The economic analyses carried out by the manufacturer and the Assessment Group, using model 1, both indicated an incremental cost per QALY gained of greater than £60,000 when pemetrexed plus cisplatin was compared with cisplatin alone in the fully supplemented population. Pemetrexed plus cisplatin, when compared with cisplatin alone, appears to have lower ICERs in patients with advanced disease and/or good performance status. The manufacturer’s economic analyses (based on indirect comparisons) using model 2 indicated more favourable ICERs for pemetrexed plus cisplatin when compared with MVP, vinorelbine and ASC. However, the assumptions underpinning model 2 are subject to high levels of uncertainty. When the assumptions were modified to reflect performance-status-adjusted survival, and resource use based on published data, the ICERs from model 2 were in line with those of pemetrexed plus cisplatin versus cisplatin alone.
4.3
Consideration of the evidence
4.3.1
The Committee reviewed the data available on the clinical and cost effectiveness of pemetrexed for the treatment of MPM, having considered evidence on the nature of the condition and the value placed on the benefits of pemetrexed by patient representatives and clinical specialists. It was also mindful of the need to take account of the effective use of NHS resources.
4.3.2
The Committee heard from clinical specialists and patient experts that pemetrexed plus cisplatin is valued as a potential treatment option in a disease area where it has demonstrated survival and quality of life advantages in an RCT and where there is incomplete evidence on the efficacy of alternative treatments.
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4.3.3
The Committee discussed the relevant comparator for pemetrexed plus cisplatin in the context of the NHS. Clinical specialists advised that cisplatin monotherapy would not normally be used to treat MPM in clinical practice in England and Wales because of a lack of evidence of its effectiveness and its relatively unfavourable adverse-effect profile. The Committee heard that there is no standard care pathway for MPM; although some patients receive chemotherapy treatment, notably with MVP or vinorelbine, many patients receive ASC only. However, the Committee was also aware that there have been no published RCTs of MVP or vinorelbine in MPM, either versus ASC or against each other. The Committee noted that the results of a meta-analysis investigating prognostic factors for MPM suggest that survival with ASC without chemotherapy may be no worse than with chemotherapy. The Committee agreed that a direct RCT comparison of the efficacy of pemetrexed plus cisplatin versus other chemotherapy treatments and ASC would be an informative addition to the evidence base.
4.3.4
The Committee discussed whether pemetrexed should be recommended over treatments for MPM used most frequently in the UK, and therefore considered the indirect comparisons submitted by the manufacturer. It discussed the plausibility of the result that pemetrexed plus cisplatin had lower ICERs when compared with MVP, vinorelbine and ASC than when it was compared with cisplatin alone. The Committee noted the high degree of uncertainty surrounding the assumptions underpinning the model and observed that the survival estimates had been taken from relatively small, non-comparative and observational studies. It also noted that the study populations were unlikely to be comparable with the population of the EMPHACIS trial, particularly in terms of performance status, a key independent predictor of survival in MPM patients.
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4.3.5
The Committee also noted that resource-use estimates for MVP and vinorelbine (based on the number of cycles of chemotherapy derived from the manufacturer’s market research surveys) were higher than those reported in the studies from which the effectiveness estimates were taken, and considered the possibility that comparator costs may have been overestimated. The Committee saw that when the model assumptions were amended to incorporate more favourable survival estimates and resource use taken from the literature, ICERs were significantly higher. On balance, the Committee concluded that it could not base its decision on the indirect comparison model.
4.3.6
The Committee heard from clinical specialists that cisplatin could be considered a valid chemotherapeutic agent even though it is not favoured in the UK. The Committee discussed what could be inferred when the comparative evidence was limited to pemetrexed and cisplatin. It concluded that the survival benefit demonstrated by pemetrexed plus cisplatin in the EMPHACIS trial was likely to be robust because cisplatin was likely to be at least as effective as placebo or ASC, although, in terms of quality of life, cisplatin is likely to have adverse effects. The Committee also noted that cisplatin was likely to have higher costs than placebo or ASC and that this would affect the results of cost-effectiveness analysis. The Committee discussed the ICERs of pemetrexed plus cisplatin versus cisplatin alone produced by the manufacturer and the Assessment Group, and observed that the range of ICERs was higher than is normally considered acceptable.
4.3.7
The Committee considered whether it was appropriate to accept economic results expressed in incremental costs per life year gained. The Committee noted that the ‘Guide to the methods of technology appraisal’ advises that the reference case measure of health benefits is the QALY, and that ‘where health gain is expressed in terms of life years gained, the range of most plausible ICERs that are acceptable will be substantially lower...’ (6.2.6.12). The Committee did not consider it plausible that a patient with MPM on
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chemotherapy would have a full quality of life and this was confirmed by the experts present at the meeting. Furthermore, the Committee heard from clinical specialists that utility values derived from studies in NSCLC are a fair approximation of the utility values for people with MPM, and noted that sensitivity analyses indicated the ICERs from the manufacturer’s economic model were not strongly influenced by the utility values. The Committee agreed that there are no reasons for it to change its preference for QALYs.
4.3.8
The Committee discussed the subgroup of patients with both advanced disease and good performance status, in view of the relatively favourable ICERs of pemetrexed plus cisplatin versus cisplatin alone (£37,000 per QALY gained, or £34,500 per QALY gained assuming a 100-mg pemetrexed vial becomes available) that were calculated for this subgroup. The Committee was aware that most people with unresectable disease would be considered to have advanced disease and that this subgroup of patients comprised the majority of people with MPM seen in UK clinical practice. The Committee accepted that it was plausible that people with good performance status were likely to show a better response to treatment than those with poor performance status.
4.3.9
The Committee noted that not all patients respond to treatment with pemetrexed plus cisplatin and saw that, in the EMPHACIS trial, 87% of those who responded had done so within four cycles. Furthermore, the Committee noted from the consultation that it would be unusual for a UK oncologist to continue treatment beyond four cycles if there was disease progression or no response to treatment. The Committee therefore accepted that the mean number of cycles in clinical practice was likely to be less than the mean of six cycles reported in the EMPHACIS trial, and this would result in lower estimates of pemetrexed drug costs.
4.3.10
The Committee discussed the possibility that differences in symptom relief (including pain and dyspnoea) and quality of life between pemetrexed plus cisplatin and cisplatin alone may not have been captured fully by the
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economic model because the utilities for both treatment and comparator had been estimated based on data from people with NSCLC. The Committee noted that there was some evidence from the EMPHACIS trial showing that pemetrexed plus cisplatin was associated with statistically significant symptomatic improvements (especially with pain relief) compared with cisplatin alone. The Committee agreed that the economic analyses may have underestimated the overall quality of life benefits of pemetrexed in people with MPM.
4.3.11
Having considered the likelihood of lower numbers of treatment cycles in clinical practice, the potential availability of a 100-mg pemetrexed vial and the likelihood of greater quality of life benefits than assumed by the cost-effectiveness analyses, the Committee agreed that the ICER for pemetrexed plus cisplatin in the fully supplemented subgroup with advanced disease and good performance status was likely to fall within acceptable levels.
4.3.12
The Committee also noted that MPM is a rare and aggressive malignancy caused by occupational exposure to asbestos and was mindful that this disease has a very poor prognosis.
4.3.13
The Committee concluded that pemetrexed in combination with cisplatin should be recommended as an option for the treatment of MPM only in people who are considered to have advanced disease and who have a WHO performance status of 0 or 1, in whom surgical resection is not considered appropriate.
5
Implementation
5.1
The Healthcare Commission assesses the performance of NHS organisations in meeting core and developmental standards set by the Department of Health in ‘Standards for better health’ issued in July 2004. The Secretary of State has directed that the NHS provides funding and resources for medicines and treatments that have been recommended by NICE technology appraisals
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5.2
'Healthcare standards for Wales’ was issued by the Welsh Assembly Government in May 2005 and provides a framework both for self-assessment by healthcare organisations and for external review and investigation by Healthcare Inspectorate Wales. Standard 12a requires healthcare organisations to ensure that patients and service users are provided with effective treatment and care that conforms to NICE technology appraisal guidance. The Assembly Minister for Health and Social Services issued a Direction in October 2003 that requires local health boards and NHS trusts to make funding available to enable the implementation of NICE technology appraisal guidance, normally within 3 months.
5.3
NICE has developed tools to help organisations implement this guidance (listed below). These are available on our website (www.nice.org.uk/TA135).
•
A costing statement explaining the resource impact of this guidance.
•
Audit criteria to monitor local practice.
6
Recommendation for further research
6.1
The Committee identified a need for RCTs comparing alternative chemotherapy regimens in MPM. Specifically, the Committee recommended that trials be conducted in which pemetrexed plus cisplatin is compared with treatments that are currently commonly used in clinical practice in England and Wales in order to determine its relative effectiveness. The Committee also recommended that comparative trials of pemetrexed plus cisplatin versus other promising treatments be conducted.
7
Related NICE guidance
7.1
There is no related guidance for this technology.
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8
Review of guidance
8.1
The review date for a technology appraisal refers to the month and year in which the Guidance Executive will consider whether the technology should be reviewed. This decision will be taken in the light of information gathered by the Institute, and in consultation with consultees and commentators.
8.2
The guidance on this technology will be considered for review in September 2010.
Andrew Dillon Chief Executive January 2008
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Appendix A: Appraisal Committee members and NICE project team
A Appraisal Committee members
The Appraisal Committee is a standing advisory committee of the Institute. Its members are appointed for a 3-year term. A list of the Committee members who took part in the discussions for this appraisal appears below. The Appraisal Committee meets three times a month except in December, when there are no meetings. The Committee membership is split into three branches, each with a chair and vice-chair. Each branch considers its own list of technologies, and ongoing topics are not moved between the branches.
Committee members are asked to declare any interests in the technology to be appraised. If it is considered there is a conflict of interest, the member is excluded from participating further in that appraisal.
The minutes of each Appraisal Committee meeting, which include the names of the members who attended and their declarations of interests, are posted on the NICE website.
Professor Keith Abrams Professor of Medical Statistics, University of Leicester
Dr Jeff Aronson Reader in Clinical Pharmacology, Radcliffe Infirmary, Oxford
Dr Darren Ashcroft Senior Clinical Lecturer, School of Pharmacy and Pharmaceutical Sciences, University of Manchester
Professor David Barnett Professor of Clinical Pharmacology, University of Leicester
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Dr Peter Barry Consultant in Paediatric Intensive Care, Leicester Royal Infirmary
Professor Stirling Bryan Director of the Health Economics Facility, University of Birmingham
Mr Brian Buckley Vice Chairman, InContact
Professor John Cairns Public Health and Policy, London School of Hygiene and Tropical Medicine
Professor Mike Campbell Statistician, University of Sheffield
Professor David Chadwick Professor of Neurology, Walton Centre for Neurology and Neurosurgery
Dr Mark Chakravarty Head of Government Affairs and NHS Policy, Procter and Gamble Pharmaceuticals (UK) Ltd
Dr Peter I Clark Honorary Chairman, Association of Cancer Physicians
Dr Mike Davies Consultant Physician, University Department of Medicine & Metabolism, Manchester Royal Infirmary
Mr Richard Devereaux-Phillips Public Affairs Manager, Medtronic Ltd
Professor Jack Dowie Health Economist, London School of Hygiene and Tropical Medicine
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Lynn Field Nurse Director, Pan Birmingham Cancer Network
Professor Christopher Fowler Professor of Surgical Education, University of London
Dr Fergus Gleeson Consultant Radiologist, Churchill Hospital, Oxford
Ms Sally Gooch Former Director of Nursing & Workforce Development, Mid Essex Hospitals Services NHS Trust
Mrs Barbara Greggains Lay Member
Mr Sanjay Gupta Former Stroke Services Manager, Basildon and Thurrock Universities Hospitals NHS Trust
Professor Philip Home Professor of Diabetes Medicine, University of Newcastle upon Tyne
Dr Peter Jackson Clinical Pharmacologist, University of Sheffield
Professor Peter Jones Professor of Statistics & Dean Faculty of Natural Sciences, Keele University
Dr Mike Laker Medical Director, Newcastle Hospitals NHS Trust
Dr George Levvy Lay Member
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Ms Rachel Lewis Nurse Adviser to the Department of Health
Mr Terence Lewis Mental Health Consultant, National Institute for Mental Health in England
Professor Jonathan Michaels Professor of Vascular Surgery, University of Sheffield
Professor Gary McVeigh Professor of Cardiovascular Medicine, Queen’s University, Belfast
Dr Ruairidh Milne Senior Lecturer in Health Technology Assessment, National Coordinating Centre for Health Technology
Dr Neil Milner General Medical Practitioner, Tramways Medical Centre, Sheffield
Dr Rubin Minhas General Practitioner, CHD Clinical Lead, Medway PCT
Dr John Pounsford Consultant Physician, North Bristol NHS Trust
Dr Rosalind Ramsay Consultant Psychiatrist, Adult Mental Health Services, Maudsley Hospital
Dr Stephen Saltissi Consultant Cardiologist, Royal Liverpool University Hospital
Dr Lindsay Smith General Practitioner, East Somerset Research Consortium
Mr Cliff Snelling Lay Member
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Mr Miles Scott Chief Executive, Bradford Teaching Hospitals NHS Foundation Trust
Dr Ken Stein Senior Lecturer, Peninsula Technology Assessment Group (PenTAG), University of Exeter
Professor Andrew Stevens Professor of Public Health, University of Birmingham
B NICE project team
Each technology appraisal is assigned to a team consisting of one or more health technology analysts (who act as technical leads for the appraisal), a technical adviser and a project manager.
Ebenezer Tetteh Technical Lead
Janet Robertson Technical Adviser
Reetan Patel Project Manager
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Appendix B: Sources of evidence considered by the Committee
A
The assessment report for this appraisal was prepared by Liverpool Reviews & Implementation Group, University of Liverpool.
•
Dundar Y, Bagust A, Dickson R et al. Pemetrexed disodium for the treatment of malignant pleural mesothelioma: a systematic review and economic evaluation (December 2005)
B
The following organisations accepted the invitation to participate in this appraisal. They were invited to comment on the draft scope, assessment report, and the appraisal consultation document (ACD). Organisations listed in I and II were also invited to make written submissions and have the opportunity to appeal against the final appraisal determination.
I
Manufacturer/sponsor:
•
Eli Lilly and Company
II
Professional/specialist and patient/carer groups:
•
Asbestos Awareness Wales/UK
•
Asbestos Diseases UK
•
Association of Cancer Physicians
•
Association for Palliative Medicine of Great Britain
•
British Mesothelioma Interest Group (BMIG)
•
British Oncology Pharmacy Association
•
British Psychosocial Oncology Society
•
British Thoracic Society (Lung Cancer and Mesothelioma Working party)
•
Cancerbackup
•
Cancer Research UK
•
Cancer Voices
NICE technology appraisal guidance 135 26
•
June Hancock Mesothelioma Research Fund
•
Long Term Medical Conditions Alliance
•
Macmillan Cancer Relief
•
Marie Curie Cancer Care
•
National Cancer Alliance
•
National Council for Palliative Care
•
National Lung Cancer Forum for Nurses
•
Occupational and Environmental Diseases Association
•
Ridings Asbestos Support and Awareness Group (RASAG)
•
Roy Castle Lung Cancer Foundation
•
Royal College of Nursing
•
Royal College of Physicians’ Intercollegiate Lung Cancer Group
•
Royal College of Physicians’ Medical Oncology Joint Special Committee
•
Royal College of Radiologists
•
Royal Pharmaceutical Society
•
Society of Cardiothoracic Surgeons of Great Britain and Ireland
•
Society of Radiographers
•
Tenovus Cancer Information Centre
III
Commentator organisations (without the right of appeal):
•
Approved Prescription Services (cisplatin)
•
Bristol-Myers Squibb Pharmaceuticals (cisplatin)
•
British National Formulary
•
British Thoracic Oncology Group
•
GMB Union
•
Institute of Cancer Research
•
Liverpool Reviews and Implementation Group
•
Mayne Pharma (cisplatin)
•
MRC Clinical Trials Unit
NICE technology appraisal guidance 135 27
NICE technology appraisal guidance 135 28
•
National Cancer Research Institute
•
National Coordinating Centre for Health Technology Assessment
•
National Public Health Service for Wales
•
NHS Confederation
•
NHS Purchasing and Supplies Agency
•
NHS Quality Improvement Scotland
•
Transport & General Workers Union
•
Welsh Assembly Government
C
The following individuals were selected from clinical specialist and patient advocate nominations from the non-manufacturer/sponsor consultees and commentators. They participated in the Appraisal Committee discussions and provided evidence to inform the Appraisal Committee’s deliberations. They gave their expert personal view on pemetrexed for malignant pleural mesothelioma by attending the initial Committee discussion and/or providing written evidence to the Committee. They were also invited to comment on the ACD.
•
Dr Mary O’Brien, Consultant Medical Oncologist, Institute of Cancer Research, nominated by the Institute of Cancer Research – clinical specialist
•
Dr Robin Rudd, Consultant Physician, British Thoracic Society, nominated by the British Thoracic Society – clinical specialist
•
Ms Liz Darlison, Consultant Nurse, Mesothelioma UK, nominated by June Hancock Mesothelioma Research Fund – patient expert
•
Macmillan Lung Nurse Specialist, Harrogate District Hospital, nominated by June Hancock Mesothelioma Research Fund – patient expert
source :www.nice.org.uk/TA135
Showing posts with label Mesothelioma Treatment. Show all posts
Showing posts with label Mesothelioma Treatment. Show all posts
Sunday, January 25, 2009
Wednesday, January 21, 2009
Types of Mesothelioma
Pleural mesothelioma
Pleural mesothelioma is the most common type of malignant mesothelioma. Around two thirds of those diagnosed have the pleural mesothelioma type. This form of mesothelioma affects cells in the pleura, the name given to the lining of the lungs and chest cavity. The pleura has two layers: the parietal layer (an outer layer that lines the chest cavity and diaphragm) and the visceral layer (an inner layer that lines the lungs).
Asbestos Exposure & Pleural Mesothelioma
People who are exposed to asbestos breathe in tiny asbestos fibers that enter the pleura of the lungs. Once in the lungs, these asbestos fibers then cause changes in pleural cells that cause them to become cancerous.
Symptoms of Pleural Mesothelioma
All forms of mesothelioma are particularly dangerous because two or three decades can elapse between asbestos exposure and the onset of cancer symptoms. In addition, the early symptoms of mesothelioma cancer are non-specific, and these symptoms often resemble those of a simple and non-threatening viral infection.
Symptoms of pleural mesothelioma can include the following:
* Persistent coughing, rasping, difficulty in breathing or swallowing, coughing up blood
* Weight loss
* Fever or night sweats
* Swelling of the facial area
* Shortness of breath, even when resting
* Severe chest pain, or pain in the rib area
Pleural Mesothelioma Diagnosis
Diagnosis of pleural mesothelioma is typically made on the basis of these symptoms and on the results of a more thorough physical examination. Chest x-rays, CT scans, and MRI scans are all commonly used during diagnosis, and will also help to determine an appropriate course of mesothelioma treatment , as these procedures will show whether or not the cancer has spread from its point of origin.
Diagnosis is confirmed with a needle biopsy, tissue biopsy, or both. During a needle biopsy, fluid is drawn from the area and is then tested for the presence of cancer cells. A tissue biopsy usually involves a relatively non-invasive surgical procedure called laparoscopy, in which a small piece of tissue is removed from the affected area, to be tested for the presence of malignant cells.
Pleural Mesothelioma Treatment
Due to the nature of mesothelioma, diagnosis is often not made until the cancer has progressed to a stage at which curative treatment is not possible. Most treatments for pleural mesothelioma are palliative and are carried out to relieve the symptoms and improve the patient's quality of life. Conventional treatment options are limited to surgery, chemotherapy and radiation therapy.
In cases where curative surgery is attempted, the patient must be in otherwise good health, and the disease must not have spread far beyond its point of origin. In such cases, part or all of one lung may be removed.
Malignant mesothelioma
Malignant mesothelioma is a very aggressive cancer—it is resistant to all currently known types of treatment. People affected by this type of mesothelioma cancer have a very poor prognosis; the one-year survival rate of those diagnosed with mesothelioma is just 50%.
The principal cause of mesothelioma cancer is asbestos exposure , and due to high rates of asbestos exposure in the twentieth century, the incidence rate of mesothelioma is steadily increasing and is likely to continue to increase for the next several decades.
How Asbestos Causes Cancer
The exact method by which asbestos causes cancer in mesothelial cells is presently unknown. However, there are four different theories:
1. Asbestos causes irritation of mesothelial cells, leading to cell damage and eventually cancer
2. Asbestos fibers enter mesothelial cells and damage molecules that are crucial for normal cell division
3. Asbestos fibers promote the formation of free radicals, which cause damage to DNA and cause mesothelial cells to mutate into cancer cells
4. Asbestos fibers cause mesothelial cells to produce molecules called oncoproteins that cause them to turn into cancer cells
As with all other types of malignant cancer, the key element is that cells are caused to divide continuously. These cells eventually form tumors that prevent other cells and organs from functioning normally.
Symptoms of Malignant Mesothelioma
Early symptoms of malignant mesothelioma are non-specific and may often resemble viral infections—this means that early diagnosis of this type of cancer is difficult. Symptoms such as shortness of breath, chest pain, or a persistent cough are not uncommon. Night sweats, fever, and weight loss are less common in people with pleural mesothelioma. Symptoms of peritoneal mesothelioma include pain or swelling in the abdominal area, nausea, weight loss, obstructions in the bowel, and anemia.
Diagnosis of Malignant Mesothelioma
Diagnosing malignant mesothelioma quickly and accurately is very important for two reasons. First, correct diagnosis is essential so that patients can be treated with a minimum of delay. The second reason is that some patients may wish to try and obtain some kind of financial compensation from the company that was responsible for their asbestos cancer exposure.
Diagnosis is made on the basis of the patient's symptoms, in conjunction with a physical examination. This might include chest x-rays as well as other procedures that are designed to find out what type of cancer is involved and what stage it is at. The diagnosis is confirmed with biopsies or blood tests that determine whether or not cancerous cells are present in the body.
Prognosis of Malignant Mesothelioma
Mesothelioma prognosis (life expectancy) for people with malignant mesothelioma is generally very poor. Early symptoms of the disease are so non-specific that this type of cancer is difficult to diagnose early, and by the time an accurate diagnosis is confirmed, around 50% of patients will die within one year.
Treatment for Mesothelioma Cancer
The most common treatments for malignant mesothelioma are surgery and chemotherapy, which are usually used in conjunction with each other. Surgical procedures typically involve removing malignant cells to improve the patient's quality of life and are usually followed up with chemotherapy to remove residual cancer cells.
Other forms of treatment are largely experimental. These types of treatment include immunotherapy and gene therapy. Immunotherapy involves manipulating the body's own immune system in an effort to induce it to kill cancer cells. Gene therapy involves using a virus that has been genetically engineered to infect cancer cells and cause them to produce molecules that are capable of killing only malignant mesothelioma cells.
Peritoneal mesothelioma
Peritoneal mesothelioma attacks the peritoneum, a tissue in the body's abdomen. This type of mesothelioma cancer accounts for 10%–20% of all cases of mesothelioma. It's different from the most common form of mesothelioma, which attacks the pleura, a tissue lining in the chest. The mesothelioma cancer symptoms are different, and the prognosis is different too. However, as with all variants of mesothelioma cancer, peritoneal mesothelioma is almost always traceable to exposure to asbestos, the carcinogenic mineral used widely in the years before strict regulations were imposed in the 1980s.
A Rare Form of Mesothelioma Cancer
About 100 to 500 cases of peritoneal mesothelioma are diagnosed each year in the United States. Almost all of the individuals who are diagnosed with this cancer have a clear history of asbestos exposure. In many cases, pleural (chest) mesothelioma can spread to the peritoneal cavity, but this would still be a diagnosis of pleural mesothelioma (that has metastasized), not peritoneal mesothelioma that begins in the peritoneum.
Symptoms of Peritoneal Mesothelioma
Peritoneal mesothelioma signs and symptoms may include:
* Abdominal swelling
* Lumps of tissue in the abdomen
* Abdominal pain
* A change in bowel habits, e.g., frequent diarrhea or constipation
* Unexplained weight loss
Unfortunately, it's often the case that the peritoneal mesothelioma doesn't show any symptoms until it's pretty far along.
The Diagnosis of Peritoneal Mesothelioma
People who are eventually diagnosed with peritoneal mesothelioma usually first see their doctor with a symptom for abdominal swelling. There are other possible causes of abdominal swelling besides peritoneal mesothelioma, such as cirrhosis of the liver. It can take some time and a battery of medical tests to correctly identify peritoneal mesothelioma.
Once the peritoneal mesothelioma is correctly diagnosed, it is difficult to predict how aggressive it will be in an individual patient, because this variant of mesothelioma has shown a wide spectrum of behavior. A patient may have recurring and severe bouts of lower abdominal pain, or not. The cancer could also metastasize from the peritoneum to lymph nodes.
Treatment for Peritoneal Mesothelioma
There is as yet no cure for peritoneal mesothelioma. However, some studies are showing promising results. It's best to ask your physician about the specifics of your case — the stage of the cancer, its location, the prognosis, and potential mesothelioma treatment options.
Pericardial Mesothelioma
Pericardial mesothelioma is the rarest type of mesothelioma cancer . The pericardium is a fluid-filled sac made out of thin tissue, covering the heart and providing it with crucial lubrication. Pericardial mesothelioma is, in effect, cancerous growths on the pericardium.
The Prevalence of Pericardial Mesothelioma
It's estimated that about 5% to perhaps 10% of people who develop mesothelioma have the pericardial-mesothelioma subtype. The accurate incidence is difficult to estimate because pericardial mesothelioma is easily mistaken for another disease, such as cardiovascular disease. The signs and symptoms are similar in both cases. In addition, when a patient is finally diagnosed with mesothelioma cancer, it is often a different type of mesothelioma cancer that is recognized first — such as secondary lung cancer.
However, pericardial mesothelioma is always traced to asbestos exposure, whereas cardiovascular disease is not.
How Pericardial Mesothelioma Develops
When the microscopic-sized fibers of which asbestos is composed are in the air, they can be inhaled by individuals in the area. Oftentimes, people are completely unaware that they have breathed in a toxic amount of asbestos. The fibers lodge themselves in the lungs and other organs.
It is unclear how asbestos fibers get to the pericardium, because there is no clear path that fibers can travel to the pericardium. One theory is that the fibers push their way through the lining of the lungs; another theory is that the fibers are carried through the blood stream to the pericardium.
In any case, the fibers become lodged in and around the pericardium, beginning the cancer process.
Symptoms of Pericardial Mesothelioma
Symptoms that are most prevalent with patients who suffer from pericardial mesothelioma include:
* irregular heart beat
* chest palpitations
* chest pain
* cough
* shortness of breath
If you are experiencing these symptoms and have not yet consulted a physician, see a doctor soon.
What Can Be Done for Pericardial Mesothelioma?
There are a few ways to help treat pericardial mesothelioma, but there is as yet no cure for this cancer. Chemotherapy, radiation, a combination of these, and surgery can be used to treat the cancer and alleviate the discomfort that a patient with pericardial mesothelioma may be experiencing. The success rate of the treatment depends in part on the stage of the mesothelioma cancer and the patient's general health.
Pleural mesothelioma is the most common type of malignant mesothelioma. Around two thirds of those diagnosed have the pleural mesothelioma type. This form of mesothelioma affects cells in the pleura, the name given to the lining of the lungs and chest cavity. The pleura has two layers: the parietal layer (an outer layer that lines the chest cavity and diaphragm) and the visceral layer (an inner layer that lines the lungs).
Asbestos Exposure & Pleural Mesothelioma
People who are exposed to asbestos breathe in tiny asbestos fibers that enter the pleura of the lungs. Once in the lungs, these asbestos fibers then cause changes in pleural cells that cause them to become cancerous.
Symptoms of Pleural Mesothelioma
All forms of mesothelioma are particularly dangerous because two or three decades can elapse between asbestos exposure and the onset of cancer symptoms. In addition, the early symptoms of mesothelioma cancer are non-specific, and these symptoms often resemble those of a simple and non-threatening viral infection.
Symptoms of pleural mesothelioma can include the following:
* Persistent coughing, rasping, difficulty in breathing or swallowing, coughing up blood
* Weight loss
* Fever or night sweats
* Swelling of the facial area
* Shortness of breath, even when resting
* Severe chest pain, or pain in the rib area
Pleural Mesothelioma Diagnosis
Diagnosis of pleural mesothelioma is typically made on the basis of these symptoms and on the results of a more thorough physical examination. Chest x-rays, CT scans, and MRI scans are all commonly used during diagnosis, and will also help to determine an appropriate course of mesothelioma treatment , as these procedures will show whether or not the cancer has spread from its point of origin.
Diagnosis is confirmed with a needle biopsy, tissue biopsy, or both. During a needle biopsy, fluid is drawn from the area and is then tested for the presence of cancer cells. A tissue biopsy usually involves a relatively non-invasive surgical procedure called laparoscopy, in which a small piece of tissue is removed from the affected area, to be tested for the presence of malignant cells.
Pleural Mesothelioma Treatment
Due to the nature of mesothelioma, diagnosis is often not made until the cancer has progressed to a stage at which curative treatment is not possible. Most treatments for pleural mesothelioma are palliative and are carried out to relieve the symptoms and improve the patient's quality of life. Conventional treatment options are limited to surgery, chemotherapy and radiation therapy.
In cases where curative surgery is attempted, the patient must be in otherwise good health, and the disease must not have spread far beyond its point of origin. In such cases, part or all of one lung may be removed.
Malignant mesothelioma
Malignant mesothelioma is a very aggressive cancer—it is resistant to all currently known types of treatment. People affected by this type of mesothelioma cancer have a very poor prognosis; the one-year survival rate of those diagnosed with mesothelioma is just 50%.
The principal cause of mesothelioma cancer is asbestos exposure , and due to high rates of asbestos exposure in the twentieth century, the incidence rate of mesothelioma is steadily increasing and is likely to continue to increase for the next several decades.
How Asbestos Causes Cancer
The exact method by which asbestos causes cancer in mesothelial cells is presently unknown. However, there are four different theories:
1. Asbestos causes irritation of mesothelial cells, leading to cell damage and eventually cancer
2. Asbestos fibers enter mesothelial cells and damage molecules that are crucial for normal cell division
3. Asbestos fibers promote the formation of free radicals, which cause damage to DNA and cause mesothelial cells to mutate into cancer cells
4. Asbestos fibers cause mesothelial cells to produce molecules called oncoproteins that cause them to turn into cancer cells
As with all other types of malignant cancer, the key element is that cells are caused to divide continuously. These cells eventually form tumors that prevent other cells and organs from functioning normally.
Symptoms of Malignant Mesothelioma
Early symptoms of malignant mesothelioma are non-specific and may often resemble viral infections—this means that early diagnosis of this type of cancer is difficult. Symptoms such as shortness of breath, chest pain, or a persistent cough are not uncommon. Night sweats, fever, and weight loss are less common in people with pleural mesothelioma. Symptoms of peritoneal mesothelioma include pain or swelling in the abdominal area, nausea, weight loss, obstructions in the bowel, and anemia.
Diagnosis of Malignant Mesothelioma
Diagnosing malignant mesothelioma quickly and accurately is very important for two reasons. First, correct diagnosis is essential so that patients can be treated with a minimum of delay. The second reason is that some patients may wish to try and obtain some kind of financial compensation from the company that was responsible for their asbestos cancer exposure.
Diagnosis is made on the basis of the patient's symptoms, in conjunction with a physical examination. This might include chest x-rays as well as other procedures that are designed to find out what type of cancer is involved and what stage it is at. The diagnosis is confirmed with biopsies or blood tests that determine whether or not cancerous cells are present in the body.
Prognosis of Malignant Mesothelioma
Mesothelioma prognosis (life expectancy) for people with malignant mesothelioma is generally very poor. Early symptoms of the disease are so non-specific that this type of cancer is difficult to diagnose early, and by the time an accurate diagnosis is confirmed, around 50% of patients will die within one year.
Treatment for Mesothelioma Cancer
The most common treatments for malignant mesothelioma are surgery and chemotherapy, which are usually used in conjunction with each other. Surgical procedures typically involve removing malignant cells to improve the patient's quality of life and are usually followed up with chemotherapy to remove residual cancer cells.
Other forms of treatment are largely experimental. These types of treatment include immunotherapy and gene therapy. Immunotherapy involves manipulating the body's own immune system in an effort to induce it to kill cancer cells. Gene therapy involves using a virus that has been genetically engineered to infect cancer cells and cause them to produce molecules that are capable of killing only malignant mesothelioma cells.
Peritoneal mesothelioma
Peritoneal mesothelioma attacks the peritoneum, a tissue in the body's abdomen. This type of mesothelioma cancer accounts for 10%–20% of all cases of mesothelioma. It's different from the most common form of mesothelioma, which attacks the pleura, a tissue lining in the chest. The mesothelioma cancer symptoms are different, and the prognosis is different too. However, as with all variants of mesothelioma cancer, peritoneal mesothelioma is almost always traceable to exposure to asbestos, the carcinogenic mineral used widely in the years before strict regulations were imposed in the 1980s.
A Rare Form of Mesothelioma Cancer
About 100 to 500 cases of peritoneal mesothelioma are diagnosed each year in the United States. Almost all of the individuals who are diagnosed with this cancer have a clear history of asbestos exposure. In many cases, pleural (chest) mesothelioma can spread to the peritoneal cavity, but this would still be a diagnosis of pleural mesothelioma (that has metastasized), not peritoneal mesothelioma that begins in the peritoneum.
Symptoms of Peritoneal Mesothelioma
Peritoneal mesothelioma signs and symptoms may include:
* Abdominal swelling
* Lumps of tissue in the abdomen
* Abdominal pain
* A change in bowel habits, e.g., frequent diarrhea or constipation
* Unexplained weight loss
Unfortunately, it's often the case that the peritoneal mesothelioma doesn't show any symptoms until it's pretty far along.
The Diagnosis of Peritoneal Mesothelioma
People who are eventually diagnosed with peritoneal mesothelioma usually first see their doctor with a symptom for abdominal swelling. There are other possible causes of abdominal swelling besides peritoneal mesothelioma, such as cirrhosis of the liver. It can take some time and a battery of medical tests to correctly identify peritoneal mesothelioma.
Once the peritoneal mesothelioma is correctly diagnosed, it is difficult to predict how aggressive it will be in an individual patient, because this variant of mesothelioma has shown a wide spectrum of behavior. A patient may have recurring and severe bouts of lower abdominal pain, or not. The cancer could also metastasize from the peritoneum to lymph nodes.
Treatment for Peritoneal Mesothelioma
There is as yet no cure for peritoneal mesothelioma. However, some studies are showing promising results. It's best to ask your physician about the specifics of your case — the stage of the cancer, its location, the prognosis, and potential mesothelioma treatment options.
Pericardial Mesothelioma
Pericardial mesothelioma is the rarest type of mesothelioma cancer . The pericardium is a fluid-filled sac made out of thin tissue, covering the heart and providing it with crucial lubrication. Pericardial mesothelioma is, in effect, cancerous growths on the pericardium.
The Prevalence of Pericardial Mesothelioma
It's estimated that about 5% to perhaps 10% of people who develop mesothelioma have the pericardial-mesothelioma subtype. The accurate incidence is difficult to estimate because pericardial mesothelioma is easily mistaken for another disease, such as cardiovascular disease. The signs and symptoms are similar in both cases. In addition, when a patient is finally diagnosed with mesothelioma cancer, it is often a different type of mesothelioma cancer that is recognized first — such as secondary lung cancer.
However, pericardial mesothelioma is always traced to asbestos exposure, whereas cardiovascular disease is not.
How Pericardial Mesothelioma Develops
When the microscopic-sized fibers of which asbestos is composed are in the air, they can be inhaled by individuals in the area. Oftentimes, people are completely unaware that they have breathed in a toxic amount of asbestos. The fibers lodge themselves in the lungs and other organs.
It is unclear how asbestos fibers get to the pericardium, because there is no clear path that fibers can travel to the pericardium. One theory is that the fibers push their way through the lining of the lungs; another theory is that the fibers are carried through the blood stream to the pericardium.
In any case, the fibers become lodged in and around the pericardium, beginning the cancer process.
Symptoms of Pericardial Mesothelioma
Symptoms that are most prevalent with patients who suffer from pericardial mesothelioma include:
* irregular heart beat
* chest palpitations
* chest pain
* cough
* shortness of breath
If you are experiencing these symptoms and have not yet consulted a physician, see a doctor soon.
What Can Be Done for Pericardial Mesothelioma?
There are a few ways to help treat pericardial mesothelioma, but there is as yet no cure for this cancer. Chemotherapy, radiation, a combination of these, and surgery can be used to treat the cancer and alleviate the discomfort that a patient with pericardial mesothelioma may be experiencing. The success rate of the treatment depends in part on the stage of the mesothelioma cancer and the patient's general health.
Diagnosis of Mesothelioma Cancer and Mesothelioma Treatment
Mesothelioma cancer is a disease that is particularly difficult to diagnose. Due to its latent onset and nonspecific symptoms, a person suffering from mesothelioma might go decades before a proper diagnosis and mesothelioma treatment is sought out. Dealing with mesothelioma cancer in its latter stages makes fighting the cancer that much more difficult. Below is a list of different clinical procedures your physician might perform in diagnosing the disease.
As a first step in diagnosing the disease, doctors will often arrange for image testing.
* Chest tomograms: A series of x-ray pictures of the chest taken in the frontal or lateral view producing a three-dimensional image. Tomograms have the ability to show the chest region at various depths and further detect small masses not seen on regular film.
* Pulmonary angiography: Dye is injected into a blood vessel and x-rays are taken of the arteries or veins in the lung.
* Standard CT, CAT, or MRI scans: Magnetic and computerized reconstruction of x-ray images. Such tests are used to detect abnormalities in x-ray absorption in the abdomen, chest, or head. If a patient’s tissues do in fact show an abnormal capacity for absorbing the x-rays, doctors will often proceed by performing a biopsy.
More aggressive diagnosis follows in the form of a biopsy. A biopsy is where living tissue is removed from the body and viewed under a microscope. There are several methods of tissue biopsy that are used to test for mesothelioma cancer.
* Open biopsy: The most common and preferred method is open biopsy. Open biopsy is considered the most accurate and conclusive in making a diagnosis of mesothelioma cancer because it allows for the collection of bigger tissue samples
* Thoracoscopy and laparoscopy: Entails inserting a small camera to look at and probe into the affected area.
* Needle biopsy: Doctors may also choose to collect tissue samples by inserting a hallow needle into a patient’s skin and removing cells this way.
*If you are already aware of having been exposed to asbestos cancer, contact your doctor or a mesothelioma cancer center immediately for prompt diagnosis and treatment of the disease.
As a first step in diagnosing the disease, doctors will often arrange for image testing.
* Chest tomograms: A series of x-ray pictures of the chest taken in the frontal or lateral view producing a three-dimensional image. Tomograms have the ability to show the chest region at various depths and further detect small masses not seen on regular film.
* Pulmonary angiography: Dye is injected into a blood vessel and x-rays are taken of the arteries or veins in the lung.
* Standard CT, CAT, or MRI scans: Magnetic and computerized reconstruction of x-ray images. Such tests are used to detect abnormalities in x-ray absorption in the abdomen, chest, or head. If a patient’s tissues do in fact show an abnormal capacity for absorbing the x-rays, doctors will often proceed by performing a biopsy.
More aggressive diagnosis follows in the form of a biopsy. A biopsy is where living tissue is removed from the body and viewed under a microscope. There are several methods of tissue biopsy that are used to test for mesothelioma cancer.
* Open biopsy: The most common and preferred method is open biopsy. Open biopsy is considered the most accurate and conclusive in making a diagnosis of mesothelioma cancer because it allows for the collection of bigger tissue samples
* Thoracoscopy and laparoscopy: Entails inserting a small camera to look at and probe into the affected area.
* Needle biopsy: Doctors may also choose to collect tissue samples by inserting a hallow needle into a patient’s skin and removing cells this way.
*If you are already aware of having been exposed to asbestos cancer, contact your doctor or a mesothelioma cancer center immediately for prompt diagnosis and treatment of the disease.
Asbestosis Cancer and Mesothelioma Treatment
Asbestosis is a lung disease caused by exposure to the mineral asbestos cancer. Chronic inflammation of lung tissue is the hallmark of asbestosis, which is significantly more common among people who have worked with asbestos in years past when there were few or no safety precautions to limit workers' exposure to this toxic mineral.
Signs and Symptoms of Asbestosis
People who have worked with asbestos, those who have been exposed to asbestos in a non-work setting, and the family members of such individuals should be aware of the signs and symptoms of asbestosis. These include:
* the slow onset of shortness of breath
* dry-sounding crackles when breathing in
* clubbing of the fingers
* respiratory failure (in advanced cases)
Asbestos is the cause of several other serious diseases in addition to asbestosis, such as lung cancer, cancer in other organs, and mesothelioma cancer, a cancer of chest-cavity tissue. The signs and symptoms of these diseases are different from those of asbestosis.
What Exactly Is Asbestosis?
When a person inhales asbestos fibers, those fibers may become lodged in the lungs, in the lungs' air sacs (the alveoli). Because the asbestos fibers are recognized by the body as a foreign substance, the body has an immune reaction to them, producing inflammation. The inflammation signals the body's attempt to destroy the invaders, but in the process, fibrous (scar) tissue is laid down in the lungs (this is known as interstitial fibrosis).
The fibrosis makes the walls of the air sacs thicker, which reduces their functioning. Shortness of breath is the final result. In advanced cases of asbestosis, the reduced lung function can induce “cor pulmonale,” or right-side heart failure.
How Might I Have Gotten Asbestosis?
People who worked in asbestos mines, or in the processing of asbestos, or with products that contain asbestos (and there are thousands of asbestos products) are at risk of developing asbestosis. The risk was greatest in the period from the 1930s to the 1980s, but even today, as older homes are renovated, asbestos-containing building materials may provide the toxic exposure that causes asbestosis.
Even people who never worked with asbestos have developed asbestosis — sometimes from asbestos ceiling or floor tiles in their place of employment, or when their spouses came home from an asbestos-related job with asbestos fibers clinging to his clothing and shoes. In most cases, the asbestosis makes itself known about five to ten years after the asbestos exposure.
What Can I Do about My Asbestosis?
There is no cure for asbestosis, only treatment such as:
* Oxygen therapy
* Respiratory physiotherapy
* Medication to thin out secretions from the lungs
If you or your family member has been diagnosed with asbestosis, it's good to learn all that you can about both your medical condition and your rights and options.
Contact Us for More Information about Asbestosis
Signs and Symptoms of Asbestosis
People who have worked with asbestos, those who have been exposed to asbestos in a non-work setting, and the family members of such individuals should be aware of the signs and symptoms of asbestosis. These include:
* the slow onset of shortness of breath
* dry-sounding crackles when breathing in
* clubbing of the fingers
* respiratory failure (in advanced cases)
Asbestos is the cause of several other serious diseases in addition to asbestosis, such as lung cancer, cancer in other organs, and mesothelioma cancer, a cancer of chest-cavity tissue. The signs and symptoms of these diseases are different from those of asbestosis.
What Exactly Is Asbestosis?
When a person inhales asbestos fibers, those fibers may become lodged in the lungs, in the lungs' air sacs (the alveoli). Because the asbestos fibers are recognized by the body as a foreign substance, the body has an immune reaction to them, producing inflammation. The inflammation signals the body's attempt to destroy the invaders, but in the process, fibrous (scar) tissue is laid down in the lungs (this is known as interstitial fibrosis).
The fibrosis makes the walls of the air sacs thicker, which reduces their functioning. Shortness of breath is the final result. In advanced cases of asbestosis, the reduced lung function can induce “cor pulmonale,” or right-side heart failure.
How Might I Have Gotten Asbestosis?
People who worked in asbestos mines, or in the processing of asbestos, or with products that contain asbestos (and there are thousands of asbestos products) are at risk of developing asbestosis. The risk was greatest in the period from the 1930s to the 1980s, but even today, as older homes are renovated, asbestos-containing building materials may provide the toxic exposure that causes asbestosis.
Even people who never worked with asbestos have developed asbestosis — sometimes from asbestos ceiling or floor tiles in their place of employment, or when their spouses came home from an asbestos-related job with asbestos fibers clinging to his clothing and shoes. In most cases, the asbestosis makes itself known about five to ten years after the asbestos exposure.
What Can I Do about My Asbestosis?
There is no cure for asbestosis, only treatment such as:
* Oxygen therapy
* Respiratory physiotherapy
* Medication to thin out secretions from the lungs
If you or your family member has been diagnosed with asbestosis, it's good to learn all that you can about both your medical condition and your rights and options.
Contact Us for More Information about Asbestosis
Monday, January 19, 2009
Mesothelioma Treatment
A diagnosis of mesothelioma is always difficult, whether it is pleural mesothelioma or another variety. Because this is such an aggressive and stubborn form of cancer, patients and their families may have a difficult time addressing the issue of treatment, but because options for mesothelioma patients are steadily increasing, the discussion of treatment is quite important, even if all hope seems lost.
Each mesothelioma case is considered individually and there is no right or wrong treatment for the disease. What's best for you or your loved one will depend on a number of factors. Diagnostic tools such as x-rays, MRIs, CT scans, and biopsies will be used to determine these factors and these tests will assist the doctor and/or oncologist in determining the best treatment for the patient in question.
What are the Options?
Cancer treatment usually focuses upon destroying malignant cells and preserving healthy ones. This can be accomplished in a number of ways. At present, mesothelioma patients are faced with three major options for treatment of their disease - surgery, radiation, and chemotherapy. What course of treatment is recommended will largely depend on these issues:
The type of mesothelioma and location of the tumor
The size of the tumor(s)
The degree to which the cancer has spread or metastasized
The stage of the cancer - beginning, advanced, etc.
The age of the patient
The overall physical health of the patient
Setting up any type of treatment may involve seeing a variety of doctors, including an oncologist (cancer specialist), pulmonologist (lung specialist), or radiologist. Patience is sometimes necessary, but doctors will no doubt set up treatment as soon as possible after diagnosis.
Surgery
Surgery can be performed on mesothelioma patients for one of two reasons: in an attempt to cure the disease or for palliative reasons in order to keep the patient more comfortable and improve the quality of life. Unfortunately, because mesothelioma is almost always diagnosed in its late stages, curative surgery is not usually an option.
As tests are developed that may help to diagnose mesothelioma at an earlier stage, surgery may become more of an option in the future. At that point, doctors may be able to attempt to remove the cancer and some of the surrounding tissue in an attempt to stabilize the disease.
More often, however, surgery is used as a palliative measure. For example, doctors may opt for a surgery called a pleurodesis, which involves injecting talc into the lungs to prevent fluid from returning. A thoracentesis, a surgical procedure that removes fluid from the lungs by means of a thin needle, may also be recommended.
In severe cases, a pleurectomy may be recommended for palliative purposes. This involves removing the pleura - the lining of the lung - and can control fluid build-up and lessen pain and breathing difficulties.
Radiation Therapy
If a patients health is too fragile for surgery or chemotherapy, radiation is often recommended. Radiation causes the fewest side effects and is usually easier to tolerate than chemo. There are a few different forms of radiation therapy available to meso patients:
External beam radiation - the preferred type to treat mesothelioma, this type of radiation comes from a machine outside the body and is aimed toward affected areas. Usually administered 5-days-a-week for up to 5 weeks, this type of radiation is often used for palliative purposes - to lessen breathing difficulties, pain, bleeding, or difficulty swallowing - but seldom has much of an effect on the mesothelioma tumors. This type of radiation may also be used in addition to surgery.
Brachytherapy - Rarely prescribed for mesothelioma, this kind of radiation places radioactive material directly inside the lung or abdomen.
Chemotherapy
Like radiation, chemotherapy provides no cure for mesothelioma but can go a long way in providing relief from the horrendous symptoms of the disease. As researchers continue to test different combinations of chemotherapy drugs, patients continue to benefit from their findings, and someday, chemo may go a lot further in prolonging the life of a mesothelioma victim.
Chemotherapy is given in pill form or injected. In the case of mesothelioma patients, the drugs are given intrapleurally (into the chest cavity) or intraperitoneally (into the abdominal cavity). Doctors usually combine two drugs for the best result. Currently, the preferred combination is Alimta© (pemetrexed) and Cisplatin, but other drugs are used in tandem if deemed preferable for a specific patient. In some cases, patients can only tolerate a single drug so only one is used for treatment.
Other drugs are given to the patient to combat the unpleasant side effects of chemo, such as medication to relieve nausea and vomiting or vitamins to replace essential ones lost during chemotherapy.
Some patients decide that the side effects of chemotherapy are too severe and opt not to receive this treatment.
Clinical Trials
Clinical trials are the study of promising new treatments for a particular disease. These trials are constantly in need of patients who are willing to try these experimental treatments before they are approved by the FDA. Patients should speak to their doctors about current clinical trials available to them and if they might qualify to be a part of a particular study. Those opting to participate in a clinical trial should carefully weigh the pros and cons before agreeing to participate.
Alternative Therapies
Alternative therapies include potential treatment for a disease or its symptoms that are not part of the conventional treatment generally recommended for patients with the disease. These might include the use of vitamins or herbs or participation in therapies such as acupuncture, massage, or hypnosis.
A Mesothelioma Cure
Following the backlash of asbestos-related exposures and illnesses, many people were wondering how scientific research was going to proceed. The response has been encouraging, with cancer specialists and other doctors working each day towards a cure for malignant mesothelioma. While a way to completely eliminate the cancer from the body does not presently exist, there are several successful mesothelioma treatment programs as well as clinical trials that are working towards developing a way to eliminate this unfortunate form of cancer.
Treatments for patients of malignant mesothelioma commonly fall in line with treatment of other lung and lung-related cancers. Curative treatments are those which remove the cancer from the body completely. While there are no cures for mesothelioma, any treatment could theoretically be curative, so long as it is successful in completely removing the cancer from the body. While the treatment may be curative, it is important to remember that curative treatments do not rule out the recurrence of the disease.
While curative treatments may not prevent the disease from recurring, it is important to be aware of current initiatives that are working towards a total cure for the disease. There have been instances of unique treatment programs that have prevented the recurrence of the disease for several years. Paul Krauss was diagnosed with mesothelioma in 1997 and given only a few months to live by his physician. Today, Paul Krauss is still alive and active and has dedicated himself towards spreading awareness of the disease and working with others in developing treatment programs that would be as successful as his has been.
Combination treatments, which integrate two or more different treatment options, such as surgery coupled with radiation, or surgery paired with radiation and chemotherapy have been successful in extending life expectancies. Researchers believe that when the right combination of therapies is found, prognoses will be far longer than anyone could have imagined when the disease first manifested. Technology has also afforded new possibilities to mesothelioma patients. CT (Computer Topography) scans have been able to map three-dimensional images of the body's internal organs for targeted chemotherapy or radiation therapy to be administered.
Another novel technique is being integrated with surgical resections of mesothelioma tumors. Heated chemotherapeutic agents have shown increased proficiency in the elimination of cancer cells. Side effects of chemotherapy have, in the past, prevented physicians from delivering an optimal dosage of the drug. However, a novel procedure known as intracavity heated chemotherapy treatment has integrated these two concepts into a successful program. Heated chemotherapeutic agent is administered directly to the affected area during the surgical removal, destroying any remaining cancer cells in the area and extending prognoses well beyond typical timeframs.
It is through technology and advancements such as these that cancer specialists and physicians are laying the groundwork for a cure.
References:
American Cancer Society: Detailed Guide: Maligant Mesothelioma Chemotherapy
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_29.asp?rnav=cri
American Cancer Society: Detailed Guide: Malignant Mesothelioma Radiation Therapy
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
American Cancer Society: Detailed Guide: Malignant Mesothelioma Surgery
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
Catalano, A., et al. "Experimental Therapy of Malignant Mesothelioma: New Perspectives from Ant-Angiogenic Treatments" Pub Med. Critical Reviews in Oncology/Hematology. 2004 May;(2):101-9.
Each mesothelioma case is considered individually and there is no right or wrong treatment for the disease. What's best for you or your loved one will depend on a number of factors. Diagnostic tools such as x-rays, MRIs, CT scans, and biopsies will be used to determine these factors and these tests will assist the doctor and/or oncologist in determining the best treatment for the patient in question.
What are the Options?
Cancer treatment usually focuses upon destroying malignant cells and preserving healthy ones. This can be accomplished in a number of ways. At present, mesothelioma patients are faced with three major options for treatment of their disease - surgery, radiation, and chemotherapy. What course of treatment is recommended will largely depend on these issues:
The type of mesothelioma and location of the tumor
The size of the tumor(s)
The degree to which the cancer has spread or metastasized
The stage of the cancer - beginning, advanced, etc.
The age of the patient
The overall physical health of the patient
Setting up any type of treatment may involve seeing a variety of doctors, including an oncologist (cancer specialist), pulmonologist (lung specialist), or radiologist. Patience is sometimes necessary, but doctors will no doubt set up treatment as soon as possible after diagnosis.
Surgery
Surgery can be performed on mesothelioma patients for one of two reasons: in an attempt to cure the disease or for palliative reasons in order to keep the patient more comfortable and improve the quality of life. Unfortunately, because mesothelioma is almost always diagnosed in its late stages, curative surgery is not usually an option.
As tests are developed that may help to diagnose mesothelioma at an earlier stage, surgery may become more of an option in the future. At that point, doctors may be able to attempt to remove the cancer and some of the surrounding tissue in an attempt to stabilize the disease.
More often, however, surgery is used as a palliative measure. For example, doctors may opt for a surgery called a pleurodesis, which involves injecting talc into the lungs to prevent fluid from returning. A thoracentesis, a surgical procedure that removes fluid from the lungs by means of a thin needle, may also be recommended.
In severe cases, a pleurectomy may be recommended for palliative purposes. This involves removing the pleura - the lining of the lung - and can control fluid build-up and lessen pain and breathing difficulties.
Radiation Therapy
If a patients health is too fragile for surgery or chemotherapy, radiation is often recommended. Radiation causes the fewest side effects and is usually easier to tolerate than chemo. There are a few different forms of radiation therapy available to meso patients:
External beam radiation - the preferred type to treat mesothelioma, this type of radiation comes from a machine outside the body and is aimed toward affected areas. Usually administered 5-days-a-week for up to 5 weeks, this type of radiation is often used for palliative purposes - to lessen breathing difficulties, pain, bleeding, or difficulty swallowing - but seldom has much of an effect on the mesothelioma tumors. This type of radiation may also be used in addition to surgery.
Brachytherapy - Rarely prescribed for mesothelioma, this kind of radiation places radioactive material directly inside the lung or abdomen.
Chemotherapy
Like radiation, chemotherapy provides no cure for mesothelioma but can go a long way in providing relief from the horrendous symptoms of the disease. As researchers continue to test different combinations of chemotherapy drugs, patients continue to benefit from their findings, and someday, chemo may go a lot further in prolonging the life of a mesothelioma victim.
Chemotherapy is given in pill form or injected. In the case of mesothelioma patients, the drugs are given intrapleurally (into the chest cavity) or intraperitoneally (into the abdominal cavity). Doctors usually combine two drugs for the best result. Currently, the preferred combination is Alimta© (pemetrexed) and Cisplatin, but other drugs are used in tandem if deemed preferable for a specific patient. In some cases, patients can only tolerate a single drug so only one is used for treatment.
Other drugs are given to the patient to combat the unpleasant side effects of chemo, such as medication to relieve nausea and vomiting or vitamins to replace essential ones lost during chemotherapy.
Some patients decide that the side effects of chemotherapy are too severe and opt not to receive this treatment.
Clinical Trials
Clinical trials are the study of promising new treatments for a particular disease. These trials are constantly in need of patients who are willing to try these experimental treatments before they are approved by the FDA. Patients should speak to their doctors about current clinical trials available to them and if they might qualify to be a part of a particular study. Those opting to participate in a clinical trial should carefully weigh the pros and cons before agreeing to participate.
Alternative Therapies
Alternative therapies include potential treatment for a disease or its symptoms that are not part of the conventional treatment generally recommended for patients with the disease. These might include the use of vitamins or herbs or participation in therapies such as acupuncture, massage, or hypnosis.
A Mesothelioma Cure
Following the backlash of asbestos-related exposures and illnesses, many people were wondering how scientific research was going to proceed. The response has been encouraging, with cancer specialists and other doctors working each day towards a cure for malignant mesothelioma. While a way to completely eliminate the cancer from the body does not presently exist, there are several successful mesothelioma treatment programs as well as clinical trials that are working towards developing a way to eliminate this unfortunate form of cancer.
Treatments for patients of malignant mesothelioma commonly fall in line with treatment of other lung and lung-related cancers. Curative treatments are those which remove the cancer from the body completely. While there are no cures for mesothelioma, any treatment could theoretically be curative, so long as it is successful in completely removing the cancer from the body. While the treatment may be curative, it is important to remember that curative treatments do not rule out the recurrence of the disease.
While curative treatments may not prevent the disease from recurring, it is important to be aware of current initiatives that are working towards a total cure for the disease. There have been instances of unique treatment programs that have prevented the recurrence of the disease for several years. Paul Krauss was diagnosed with mesothelioma in 1997 and given only a few months to live by his physician. Today, Paul Krauss is still alive and active and has dedicated himself towards spreading awareness of the disease and working with others in developing treatment programs that would be as successful as his has been.
Combination treatments, which integrate two or more different treatment options, such as surgery coupled with radiation, or surgery paired with radiation and chemotherapy have been successful in extending life expectancies. Researchers believe that when the right combination of therapies is found, prognoses will be far longer than anyone could have imagined when the disease first manifested. Technology has also afforded new possibilities to mesothelioma patients. CT (Computer Topography) scans have been able to map three-dimensional images of the body's internal organs for targeted chemotherapy or radiation therapy to be administered.
Another novel technique is being integrated with surgical resections of mesothelioma tumors. Heated chemotherapeutic agents have shown increased proficiency in the elimination of cancer cells. Side effects of chemotherapy have, in the past, prevented physicians from delivering an optimal dosage of the drug. However, a novel procedure known as intracavity heated chemotherapy treatment has integrated these two concepts into a successful program. Heated chemotherapeutic agent is administered directly to the affected area during the surgical removal, destroying any remaining cancer cells in the area and extending prognoses well beyond typical timeframs.
It is through technology and advancements such as these that cancer specialists and physicians are laying the groundwork for a cure.
References:
American Cancer Society: Detailed Guide: Maligant Mesothelioma Chemotherapy
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_29.asp?rnav=cri
American Cancer Society: Detailed Guide: Malignant Mesothelioma Radiation Therapy
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
American Cancer Society: Detailed Guide: Malignant Mesothelioma Surgery
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
Catalano, A., et al. "Experimental Therapy of Malignant Mesothelioma: New Perspectives from Ant-Angiogenic Treatments" Pub Med. Critical Reviews in Oncology/Hematology. 2004 May;(2):101-9.
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