The National Comprehensive Cancer Network (NCNN) has recently updated its treatment guidelines for malignant pleural mesothelioma for oncologists and other physicians who treat mesothelioma patients. Baron & Budd is the underwriter for NCCN's mesothelioma guidelines for patients. While the new guidelines do not offer any dramatic evolutions in treatment options, it gives patients the most up-to-date medical consensus on mesothelioma diagnosis and treatment.
Diagnosis
Although an imaging technique called low-dose computed tomography has recently gained support as a lung cancer screening tool, no screening methods are currently recommended for early mesothelioma detection. However, a CT scan is generally advised for undiagnosed patients suffering from symptoms such as chest pain, shortness of breath, cough, a lump in the chest wall, excess fluid around the lungs, weight loss and fever. If a physician suspects mesothelioma or another serious illness from the CT scan, it is crucial for patients to pursue the tests needed to confirm their diagnosis to better pursue effective treatment options.
These diagnostic tests include a pleural biopsy, a sampling of the chest cavity lining, and a thoracentesis, a sampling of the fluid around the lungs. It's important to note that a medically confirmed mesothelioma diagnosis is generally required to pursue legal action. Usually this diagnosis comes via a tissue or fluid biopsy.
When malignant pleural mesothelioma is diagnosed, further tests are done to help assess the cancer's stage (how far developed it is, whether it has spread), and also whether surgery would be appropriate.
Treatment
A treatment regiment involving surgery, chemotherapy and radiotherapy is generally recommended for patients who can endure surgery and whose tumor is operable. Chemotherapy may be administered before or after surgery.
For patients who are not able to undergo surgery, those with an advanced stage of the cancer, or those whose malignant mesothelioma is of a less common type (called sarcomatoid), chemotherapy alone is usually used.
However, the guidelines are unclear about which surgical option is best for which patients (or whether surgery is clearly better than chemotherapy), noting that research so far is inadequate to answer those questions. The extrapleural pneumonectomy (EPP), a more aggressive surgery, might be best to remove the mesothelioma tumors, but in other cases patients might fare better with pleurectomy/decortication.
When it comes to chemotherapy, a first-line approach combining the drugs cisplatin and pemetrexed is considered the "gold standard" for malignant pleural mesothelioma treatment. For patients who cannot tolerate pemetrexed or cisplatin, experts suggest gemcitabine. Patients whose overall health and functioning is impaired appear likely to fare better with a combination of carboplatin and pemetrexed. Depending on the individual, single-drug chemotherapy approaches using pemetrexed or vinorelbine might also be recommended.
Radiation therapy may also be advised for treating a patient's mesothelioma. The treatment has been shown to reduce local recurrences in selected patients who have undergone EPP surgery. Radiation alone is not recommended as a treatment for malignant pleural mesothelioma, although by itself it might be useful to relieve chest pain or for cancer that has spread to the bone or brain. Doctors can also offer other treatments to remove fluid in the lungs and aid in breathing.
The law firm of Baron and Budd, who sponsors this website, is a major supporter of NCCN. The firm's president and managing shareholder, Russell Budd, currently serves on the NCCN Foundation Board. Last year, the firm underwrote the creation of the NCCN mesothelioma guidelines for patients, which translates the clinical treatment guidelines into more patient-accessible materials. Though we are not medical experts (we're lawyers!), we understand the importance of providing medical information to mesothelioma patients from a highly trusted medical resource.
Contact us here or call us at 1.866.855.1229 for a complimentary copy of the NCCN Patient Guidelines for Mesothelioma.
