Treating Mesothelioma: Challenges, Advances, and Hope

Mesothelioma is one of the toughest cancers to treat. Its aggressive nature, late diagnosis, and historically poor response to treatments have made it a formidable challenge for medical professionals. For decades, treatment options have been limited, and the prognosis has been grim. But is there hope on the horizon?

In this post, we’ll dive into the current state of mesothelioma treatment, exploring the barriers to care, the latest advancements, and what’s being done to improve patient outcomes—particularly in high-prevalence areas like South Africa. If you or a loved one has been affected by this disease, this guide will help you understand your options and what the future might hold.

The Harsh Reality of Mesothelioma Treatment

Mesothelioma is a rare but aggressive cancer primarily caused by asbestos exposure. The challenge in treating mesothelioma is that:

• It’s usually diagnosed too late.
  By the time symptoms appear, the cancer has often spread beyond the lungs.
• Traditional cancer treatments don’t work as well.
  Mesothelioma doesn’t respond to chemotherapy, radiation, or surgery the way other cancers do.
• Specialized treatment centers are limited.
  Access to state-of-the-art care is restricted, particularly in countries like South Africa, where patients often live far from major oncology centers.

Because of these factors, many doctors have focused on palliative care—helping patients manage pain and improve quality of life rather than aggressively fighting the disease. While palliative care is critical, there’s growing interest in finding better ways to treat and extend the lives of mesothelioma patients.

Where South Africa Stands

In South Africa, mesothelioma is particularly prevalent due to the country’s history of asbestos mining. However, there are significant barriers to treatment:

• Few specialized mesothelioma treatment centers.
  Patients often need to travel long distances for specialized care.
• A lack of clinical trials.
  Without research, South African patients have limited access to experimental treatments.
• Delays in diagnosis.
  Many cases are mistaken for tuberculosis, leading to lost time and fewer treatment options.

The biggest challenge? A lack of awareness and funding. Because mesothelioma is often viewed as untreatable, little effort has gone into improving access to better therapies.

The Current Treatment Options

While there’s no cure for mesothelioma yet, treatment options have evolved. Today, the standard treatment includes a combination of:

1. Surgery

For some patients, surgery can remove most of the tumor, but only if the cancer is caught early. Two main procedures are:

• Extrapleural pneumonectomy (EPP):
  Removes the affected lung, part of the diaphragm, and surrounding tissues. A high-risk surgery, but can help prolong survival.
• Pleurectomy with decortication (P/D):
  A lung-sparing surgery that removes only the cancerous pleura (the lining of the lung). It’s less invasive and has a better quality-of-life outcome than EPP.

2. Chemotherapy

Chemotherapy is the most common treatment for mesothelioma. The gold standard is a combination of pemetrexed (Alimta) and cisplatin, which can help shrink tumors and slow the spread of the disease.

However, mesothelioma is notoriously resistant to chemotherapy, so the benefits are often limited.

3. Radiation Therapy

Radiation is often used to relieve symptoms rather than cure the disease. It can help:

• Shrink tumors pressing on nerves or organs.
• Reduce pain.
• Lower the risk of tumor regrowth after surgery.

Radiation is sometimes used in combination with surgery and chemotherapy for better results.

4. Palliative Care: Managing Pain and Symptoms

For many mesothelioma patients, the focus is on quality of life rather than aggressive treatment. Palliative care options include:

• Pain management medications (opioids, anti-inflammatory drugs).
• Thoracentesis and pleurodesis (procedures to drain fluid buildup around the lungs, reducing breathlessness).
• Supportive care like oxygen therapy and physical therapy.

Palliative care doesn’t stop the disease, but it can significantly improve comfort and daily functioning.

Breakthroughs and Future Treatments

The good news? Mesothelioma treatment is evolving, with new experimental therapies showing promise. Here’s what researchers are excited about:

1. Immunotherapy: Teaching the Body to Fight Back

Immunotherapy is one of the most exciting breakthroughs in cancer treatment. It works by helping the body’s immune system recognize and attack mesothelioma cells.

• Checkpoint inhibitors (like Keytruda and Opdivo) have shown some success in slowing mesothelioma progression.
• The CheckMate-743 trial found that a combination of nivolumab and ipilimumab helped some patients live longer than chemotherapy alone.

2. Gene Therapy: Reprogramming Cancer Cells

Gene therapy aims to alter the DNA of cancer cells to make them easier to destroy. Early trials suggest it could increase the effectiveness of chemotherapy.

3. Tumor-Treating Fields (TTFields)

This innovative treatment uses electric fields to disrupt cancer cell growth. The NovoTTF-100L device, approved in the U.S., is now being tested for mesothelioma.

4. Personalized Medicine

Doctors are increasingly looking at biomarker testing to determine which treatments will work best for individual patients.

These new approaches aren’t widely available yet, but they offer real hope for the future.

Access to Treatment in South Africa: The Challenges

Despite advances in mesothelioma treatment, access to care remains a major problem in South Africa. Some key issues include:

• Long distances to major cancer centers (most are located in Johannesburg, Cape Town, and Durban).
• Lack of specialists trained in mesothelioma treatment.
• Limited access to immunotherapy and clinical trials.
• High cost of treatment, with many therapies unavailable in public hospitals.

To improve outcomes, South Africa needs better infrastructure, more funding for research, and increased awareness of mesothelioma.

What You Can Do

If you or someone you love has been diagnosed with mesothelioma, here are some key steps to take:

1. Get a second opinion.
   Mesothelioma is rare, and not all doctors are experts in treating it.
2. Explore clinical trials.
   New treatments are emerging, and you may qualify for experimental therapies.
3. Look into support services.
   Organizations like the Cancer Association of South Africa (CANSA) offer guidance and assistance.
4. Advocate for better access to care.
   The more awareness and funding for mesothelioma, the better the treatment options will become.

Final Thoughts: A Future with Hope

Mesothelioma treatment has come a long way, but there’s still work to do. While the disease remains challenging to treat, new therapies are providing real hope for the future.

With better access to care, increased research, and continued innovation, the outlook for mesothelioma patients can improve. The fight isn’t over, and every new breakthrough brings us one step closer to making mesothelioma a treatable condition.