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Malignant Pleural Mesothelioma- Multimodal Therapy in Practice

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“Malignant pleural mesothelioma (MPM) is a deadly incurable cancer, with a median survival of approximately 9 months. The best available chemotherapy, arguably the standard of care, only yields a 40% response rate and an 11-week extension in median survival.”

Dear Cancer Coach- I am 3 yrs 3 months out from my pleuraectomy. Had hot chemo during surgery followed by chemo ( had reaction of hives). Followed by immunotherapy (Opdivo) w/severe muscle & joint pain 8 months into it).

Finally off of it this past December. Have had 3 weeks of radiation. One new spot and 3 other small spots that shrunk from immunotherapy. Having an appt w/ Dr in Boston at BWH soon to set up surgury for removal of these.

Joint & muscle pain starting to return- thinking it’s more arthritis base than immunotherapy since have been off it now for 6 moths. Got off ALL my pain meds about a month ago.

Phew!!

I will mention to my Dr about the Photodynamic Therapy (PDT). Thank you, Jane


Hi Jane,

I am sorry to read of your mesothelioma (meso) diagnosis.  Based on your post, my impression is that you are going for it in terms of multimodal therapies. If I count correctly you have already undergone surgery, heated chemotherapy (HIPEC), immunotherapy and radiation. And you are checking into PDT.

As the top article linked below explains, immunotherapy  is relatively new as a meso therapy yet it holds great potential. Having said that, the arthritis that you mention is probably a side effect of nivolumab. Your skin rash is probably a result of nivolumab as well.

Your post didn’t really ask me anything. My interpretation is that you were simply verifying the blog post about multimodal therapy for mesothelioma. Let me know if you have any questions.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeating Cancer

Recommended Reading:

Fatal Adverse Events AKA Death from Immunotherapy Drugs


Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes

“Background: Malignant pleural mesothelioma (MPM) is a highly lethal cancer with a median survival of ∼12 months even with aggressive intervention. Frontline therapy relies on systemic cisplatin and pemetrexed chemotherapy and has a response rate of ∼35–41%; currently, there are no US Food and Drug Administration approved second-line therapies for MPM. Herein, we present a patient with MPM who experienced rapid disease progression after standard therapy but who had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab…

Conclusions: We report the first case of a patient with MPM who experienced rapid disease progression after standard therapy but had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. As outcomes with traditional chemotherapy regimens remain disappointing, there is a substantial need for new approaches to MPM; our case highlights a new therapeutic opportunity even in the face of aggressive disease. Indeed, a new era of investigation utilizing immunotherapy for mesothelioma is beginning, with much anticipation…”

Management of Malignant Peritoneal Mesothelioma Using Cytoreductive Surgery and Perioperative Chemotherapy

“In conclusion, management of peritoneal mesothelioma requires careful selection of patients and appropriate use of CRS and HIPEC for patients suitable for this treatment. Complete or near-complete cytoreduction and use of platinum-based HIPEC are essential to optimize the possibility of long-term survival in these patients.”

Inflammatory Arthritis: A Newly Recognized Adverse Event of Immune Checkpoint Blockade

“Immune checkpoint inhibitor‐induced Inflammatory Arthitis (IA) is an underappreciated irAE that may be clinically severe, rapidly destructive, disabling, and impactful on quality of life. Published data from clinical trials likely underestimates the true incidence of IA, due to rheumatologic symptoms that may be recorded separately, but together represent one clinical syndrome [32].

Immune checkpoint inhibitor‐related IA in reported studies and published cases [25], [26], [27], [28] exhibit a range of appearances and require special management considerations. Thus, we, as a multi‐disciplinary team composed of rheumatologists, oncologists, clinical trialists, and both rheumatology and oncology laboratory researchers, put forward our provisional diagnostic and management recommendations of this phenomenon…”

Photodynamic therapy for malignant pleural mesothelioma: the future of treatment?

“Malignant pleural mesothelioma is a deadly incurable cancer, with a median survival of approximately 9 months. The best available chemotherapy, arguably the standard of care, only yields a 40% response rate and an 11-week extension in median survival.

Surgery, the modality most likely to be associated with prolonged remission, remains investigational and must always be combined with other modalities in an effort to treat the microscopic disease that will remain even after the most aggressive operations.

One such modality, photodynamic therapy, is a light-based cancer treatment that has features making it particularly well suited as a component of a surgery-based multimodal treatment plan.

Utilizing intraoperative photodynamic therapy has enabled development of a less drastic surgical procedure that is also yielding some encouraging survival results. A unique aspect of photodynamic therapy is its stimulation of a tumor-directed immune response, a feature that offers promise for designing future treatments.”

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