Mesothelioma: Treatment Options for an Incurable Disease

Mesothelioma is a rare and aggressive form of cancer. In most cases, the prognosis is very poor at the time of diagnosis. Generally, patients are not more than twelve months to live after a positive diagnosis of mesothelioma. Thus, the treatment options for such an aggressive and rapidly developing disease are quite limited. Mesothelioma treatment is usually palliative. In other words, the goal of treatment is to simply rid the patient of pain symptoms associated with mesothelioma. There is no hope of treatment of patients from the disease for several reasons:

(i) diagnosis occurs very late in the disease. By the time a diagnosis is made there is no hope for the patient.

(ii) development of the disease is very fast and affects critical organs like the heart and lungs.

surgery

or cytoreduction surgery involves removing all or nearly all the visible tumor. In the case of mesothelioma, usually in combination with chemotherapy to more effectively remove cancer cells. Some surgical operations aimed at treating a patient, especially if the cancer is still localized. In most other cases, surgery May only have a palliative effect as the cancerous mass smanjuje.Sljedeće types of surgery used to treat mesothelioma:

(i) pleurodesis: inserting an irritant into the pleural space causing inflammation, which closes down the pleural space, thereby inhibiting fluid accumulation (pleural effusion). Most of the symptoms associated with pleural mesothelioma can be cured with this method for a vrijeme.Thoracoscope used to it.

(ii) or Pleurectomy peritonectomy: removal of part of the chest or abdomen lining trim (depending on where the cancer ).

(iii) Decortication:. Removing all or part of the membrane covering the organs

(iv) pneumonectomy: removal of the entire affected lung (in most cases, mesothelioma develops in only one lung, so that the removal of the lung can be cured if the patient's cancer has not spread ).

Chemotherapy

Chemotherapy involves the administration of drugs that destroy cancer cells. Chemotherapy in the treatment of mesothelioma may have the following goals:

(i) Shrinkage of the tumor before surgery (neo-adjuvant chemotherapy ).

(ii) the destruction of cancer cells after surgery (adjuvant chemotherapy ).

(iii) increase the effectiveness of radiation therapy (immunotherapy ).

Chemotherapy is used in cases where cancer cells have spread beyond the initial page appears. It is also used, where the patient is a candidate for surgery.

The most commonly used drug for mesothelioma is pemetrexed, which is an inhibitor of many proteins that are required for DNA synthesis and cell replication.

Chemotherapy has different side effects because in the process of destroying cancer cells healthy cells are also damaged.

Radiotherapy

This refers to the treatment of cancer using penetrating beams of high energy. In the case of mesothelioma, radiotherapy can be used in combination with surgery in an attempt to cure or control your weight simptoma.Primjer radiotherapy is intensity-modulated radiotherapy (IMRT) that uses a computer generated image of the target cancer cells directly from a limited impact on the surrounding tissue.

Mesothelioma and New Comprehensive Approach of Cytoreductive Surgery

Another interesting study entitled "Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy" by
. Tristan D. Yan MD, NAMIC Haverić Dr. Carlos P. Carmignani Dr. David Chang MS, Paul H. Sugarbaker, MD - Cancer Volume 103, Number 4, pages 839-849, 15 February 2005 Here's an excerpt: "Summary - Background - Malignant peritoneal mesothelioma is a rare and fatal disease, until recently, treatment options were very limited and ineffective new comprehensive approach to cytoreductive surgery with perioperative intraperitoneal chemotherapy has improved survival rates for the cost of considerable morbidity and mortality as .. in other peritoneal surface malignancies. the outcome after these treatments is mainly dependent on adequate cytoreduction. The aim of this study was to determine the computed tomography (CT) scan images that are useful in patient selection for this comprehensive approach.

methods - Analysis of preoperative CT of 30 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy in one institution was performed. Based on the size of the tumor nodules remaining after cytoreductive surgery, patients were divided into 2 groups: those with residual lesions ≤ 2.5 cm (corresponding cytoreduction) and those with the rest of the lesions> 2.5 cm (suboptimal cytoreduction). CT for each patient were evaluated by a standardized scoring system with a copious reader operative findings. Thirty-nine CT parameters were obtained and statistically analyzed to determine their association with variables, test results, or adequacy of cytoreduction.

RESULTS - Seven patients (64%) in suboptimal cytoreduction group and 2 patients (11%) in the corresponding cytoreduction group had a> 5-cm tumor mass in the epigastric region (P = 0.004). Nine patients (82%) in group 2 patients and suboptimal (11%) in the corresponding groups of cytoreduction is the CT scan which showed a loss of normal architecture of the small bowel and mesentery (P <0.001). In a complex analysis of the two radiological features, none of the patients with> 5-cm tumor mass in the epigastric region and loss of normal architecture of the small intestine and mesentery had an adequate cytoreduction. Patients who did not have these two preoperative CT findings of a 94% probability of adequate cytoreduction.

CONCLUSIONS - CT effectively identified a peritoneal mesothelioma tumor at key anatomical sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT has become an accurate prognostic radiologic test for patient selection for comprehensive treatment.

CONCLUSIONS - CT effectively identified a peritoneal mesothelioma tumor at key anatomical sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT has become an accurate prognostic radiologic test for patient selection for comprehensive treatment.

Another interesting study called "anti-tumor activity of K1-LysPE38QQR, Immunotoxin targeting mesothelin, Cell-surface antigen expressed in ovarian cancer and malignant mesothelioma" by Hassan, Raffit, Viner, Jaye L Wang, Qing-Cheng, Margulies, Inger, Kreitman, Robert J, Pastan, Ira - Journal Immunotherapy:
. July / August 2000 - Volume 23 - Issue 4 - pp 473-479 Here is an excerpt: "Abstract - mesothelin, a differentiation antigen, is a 40 KD glycosylphosphatidylinositol-linked cell surface glycoprotein that is present on the surface of normal mesothelium and is expressed in many patients with epithelial ovarian cancer and malignant mesotheliomas. monoclonal antibody K1 is a murine immunoglobulin G1 that recognizes mesothelin. LysPE38QQR the truncated form of Pseudomonas Exotoxin no cell binding domain, but retains the expulsion and adenosine diphosphate-ribosylation domain. This is a lysine residue near the amino end of the available for conjugation to antibodies. to prevent chemical conjugation of antibody to lysine residues in the C-terminus of Pseudomonas Exotoxin, two lysine residues at positions 590 and 606 were mutated to glutamine, lysine and the rest at position 613 was mutated to arginine. monoclonal antibody K1 was chemically conjugated with LysPE38QQR, modifying the antibody with sulfo-succinimidyl-4-(N-maleimidomethyl) cyclohexane-1-carboxylate and coupling with SPDP N-succinimidyl 3 -. (2-pyridyldithio) propionate-modified LysPE38QQR result immunotoxin K1-LysPE38QQR is highly toxic to A431-K5 cells (human epidermoid carcinoma cell line transfected with a mesothelin expression plasmid) with half-maximal inhibitory concentration of 3-6 ng / ml. immunotoxin has negligible activity against A431 cells, which do not express mesothelin (median inhibitory concentration> 100 ng / mL). This immunotoxin also caused complete regression of tumors in nude mice that received xenografts of mesothelin-positive human cancers. These results show that immunotoxins directed against mesothelin are a therapeutic option that deserves further investigation for the treatment of ovarian cancer and malignant mesotheliomas. "