The National Comprehensive Cancer Network (NCNN) has recently revised its treatment guidelines for malignant pleural mesothelioma to help apprise oncologists, other physicians, mesothelioma patients and their families about progressive treatments. Baron & Budd sponsors NCCN’s Mesothelioma Guidelines and, after closely working with the organization, underwrote its printing. The revised edition offers few changes from the original— perhaps a comment on how new treatment developments are emerging steadily if slowly— but nonetheless it offers physicians and patients the most current medical views on mesothelioma diagnosis and treatment.
The ‘Electronic Nose’ from Australia is in preliminary clinical trials for detecting early stage mesothelioma; and an imaging technique called ‘low-dose computed tomography’ is gaining momentum as a general lung cancer screening tool— but no screening devices/methods are yet sanctioned for early mesothelioma detection.
To date a CT scan is first recommended for undiagnosed patients suffering from persistent chest pain, shortness of breath, cough, excessive lung fluid, sudden weight loss, low-grade temperature or high fever and/or a lump in the chest wall. If mesothelioma is even suspected by a physician or clinician, further tests must be pursued in order to determine a possible mesothelioma diagnosis and seek immediate treatment.
In the event a CT scan shows suspicion, the following diagnostic tests are currently sanctioned: pleural biopsy; sampling of the chest cavity lining; thoracentesis (sampling of fluid from around the lungs).
Note: When a mesothelioma diagnosis is medically confirmed via tissue or fluid biopsy, the patient is customarily urged to seek legal advice and pursue action.
A pleural mesothelioma diagnosis dictates further testing to assess the cancer’s advancement and locale; and ascertain whether surgery is appropriate.
Traditional curative and/or palliative treatment regimens entail surgery for patients who can undergo invasive procedures and when tumors are operable, chemotherapy, and radiotherapy. Chemotherapy may be administered at any time deemed effective.
For advanced mesothelioma patients unable to endure surgery or those with sarcomatoid (mesothelioma found in connective tissue) chemotherapy alone is most often desired. In some cases the guidelines do not flatly determine which direction is most optimal— or whether surgery is absolutely better than chemotherapy or vice versa. Research is advancing steadily but it is still inadequate to decide every variable.
Dr. David Sugarbaker of Boston has developed extrapleural pneumonectomy (EPP), an aggressive surgical procedure for tumor removal combined with a simultaneous chemo ‘wash’ to eradicate existing diseased tissue and prevent further development. EPP is a cutting-edge method frequently advocated; in other cases pleuroectomy/decortication is advised (pleuroectomy with decortication is removal of the lining of the lung so the underlying lung can fill with air; it is highly successful but also at high risk for complications).
Chemotherapy drugs, used alone or in certain combinations for synergistic impact, are: Cisplatin and Pemetrexed (generic for Alimta) the latter being considered the ‘gold standard’ for malignant pleural mesothelioma treatment.
In cases when a patient does not tolerate Pemetrexed or Cisplatin, Gemcitabine or Vinorelbine are other single-drug treatments. For patients whose general health condition and function are poor, experts may suggest a combination of the drugs Carboplatin and Pemetrexed.
Radiation therapy alone or in combination with chemotherapy may be effective. Radiotherapy has proven to reduce local recurrences in selected patients who have undergone EP. Radiation, however, is not strong enough as a stand-alone treatment for malignant pleural mesothelioma; it may be useful in relieving chest pain and/or repressing cancer that has spread to the bone or brain. Treatments are also administered to remove fluid in the lungs and assist in breathing.
The law firm of Baron and Budd, our website sponsor, is a strong 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 and printing of ‘NCCN Mesothelioma Guidelines’ for patients— a go-to manual that translates clinical treatment guidelines into patient-friendly materials. Though we are not medical experts (we’re lawyers!)— we understand the importance of providing medical information to mesothelioma patients from highly trusted medical resources.
Call us at 1.866.855.1229 for a complimentary copy of the NCCN Patient Guidelines for Mesothelioma.