Biphasic Mesothelioma Treatment

Biphasic Mesothelioma Treatment Options

Biphasic mesothelioma treatment options can vary for each patient due to the combination of cell types and where the cancer forms. Biphasic mesothelioma is diagnosed and treated based on which cell type, either epithelioid cells or sarcomatoid cells, make up the majority of the tumors.

Treatment options are also different for each type of mesothelioma, whether pleural mesothelioma (in the lining of the lungs) or peritoneal mesothelioma (in the lining of the abdominal cavity). Patients with a majority of epithelioid cells in their tumors may be eligible for more treatments than patients with a majority of sarcomatoid cells.

Typical mesothelioma treatment options include surgery, chemotherapy, immunotherapy and radiation. Other options include emerging treatments – such as oncolytic virus therapy, gene therapy and CAR T-cell therapy – which are available through clinical trials.

Surgery is often considered the most effective mesothelioma treatment option because surgeons can remove visible mesothelioma tumors and diseased tissue, allowing other treatments to be more effective. However, mesothelioma can spread quickly, which means surgery may not be an option for some patients. If tumors have already spread to the lungs (for pleural mesothelioma) or to other vital organs in the abdomen (for peritoneal mesothelioma), surgery may not be recommended.

Due to the complexity of biphasic mesothelioma, not all patients are eligible for mesothelioma surgery. The cell type that makes up the majority of the patient’s tumors will determine their eligibility.

Patients with a majority of epithelioid cells are more likely to be eligible for surgery as these cells are typically easier to identify and remove. However, patients with a majority of sarcomatoid cells are not usually candidates for surgery as these cells grow and spread rapidly and are difficult to differentiate from healthy tissues.

Chemotherapy is often recommended to treat mesothelioma. It is traditionally administered into the patient’s bloodstream through an IV drip. The chemotherapy drugs target areas of rapid cell growth, such as mesothelioma cancer cells, and cause them to stop replicating and die.

There are different types of chemotherapy for biphasic mesothelioma, which include systemic (intravenous) chemotherapy and heated intraoperative chemotherapy. Systemic chemotherapy is the standard method of chemotherapy.

Heated intraoperative chemotherapy is performed during surgery and involves delivering the drugs directly to the diseased location instead of traveling through the bloodstream. HIPEC, the chemotherapy method used alongside cytoreductive surgery for peritoneal mesothelioma, is a type of intraoperative chemotherapy.

Immunotherapy is a treatment option gaining more support for the treatment of biphasic mesothelioma. Specialists are beginning to favor immunotherapy over chemotherapy due to its ability to activate the immune system to fight cancer naturally – as if it were an infection or virus – and the less severe side effects. The goal of immunotherapy is to boost the immune system’s response to cancer cells and other invaders.

The FDA-approved immunotherapy drugs include Opdivo, Yervoy, and Keytruda, which have all been approved specifically for pleural mesothelioma immunotherapy. Opdivo and Yervoy are approved as a combination therapy for unresectable pleural mesothelioma (not eligible for surgery) and Keytruda is approved for unresectable pleural mesothelioma

Specialists also support the use of immunotherapy for peritoneal mesothelioma due to the success of immunotherapy in pleural mesothelioma and research in clinical trials, but the FDA has not yet approved any immunotherapy drugs for this type of mesothelioma.

These immunotherapy drugs are called immune checkpoint inhibitors. They block proteins in cancer cells from suppressing the immune system.

Immunotherapy drugs attach to mesothelioma cells, which send a signal to the immune system alerting it of an invader. Once the immune system recognizes the presence of cancer, it sends T cells (main soldier cells of the immune system) to target cells with similar antigens (proteins on cancer cells). Immunotherapy drugs now have successfully improved the immune system’s response to the mesothelioma cancer cells, and the immune system can focus on targeting the remaining cancer cells without damaging healthy cells.

Radiation is another biphasic mesothelioma treatment option used to treat pleural mesothelioma. Radiation therapy delivers high-energy radiation beams through the skin and into the diseased area with the goal of damaging tumor cells. The experience is painless for patients and similar to receiving an X-ray.

However, radiation is not a treatment option for peritoneal mesothelioma due to the vital organs in the abdominal cavity, such as the liver and intestines. Radiation beams can damage essential organs, leading to further health issues.

Mesothelioma specialists use a linear accelerator to send the radiation beams into the body. The beams do not immediately kill the cancer cells, but they do damage the cells beyond repair, which causes them to die without replicating.

There are different types of radiation therapy for biphasic mesothelioma:

• Photon radiation (traditional method)
• Intensity-modulated radiation therapy
• Proton radiation
• Intraoperative radiation therapy (directing radiation beams into the diseased area during surgery)

Multimodal therapy is the medical term used to describe combining multiple types of cancer treatments to optimize effects on tumors. Multimodal therapy for biphasic mesothelioma treatment involves a combination of:

Many specialists believe multimodal therapy is the best method for treating mesothelioma as it is often difficult to treat. Combining multiple treatments offers patients improved outcomes.

Optune Lua (NovoTTG-100F System) is an FDA-approved tumor treating fields device for the treatment of unresectable malignant pleural mesothelioma. This therapy is an option for patients with biphasic pleural mesothelioma but is not yet FDA-approved for peritoneal mesothelioma treatment.

Optune Lua is a wearable device that creates tumor treating fields, or electrical waves, to interfere with the cell division of cancer cells. The device must be worn 23 hours a day as it sends low-intensity electrical waves into the chest cavity to disrupt cancer cell growth. The electrical waves can damage and kill cancer cells, which can shrink tumors and limit the spread of mesothelioma.

Palliative care for mesothelioma focuses on improving the patient’s quality of life by addressing their physical and emotional needs. The primary methods of improving a mesothelioma patient’s quality of life include minimizing cancer symptoms, pain management, managing treatment side effects, and providing emotional and spiritual support.

Palliative care often involves “maintenance” chemotherapy, which is the administration of chemotherapy drugs at a lower dose to maintain the stage of cancer, prevent it from spreading, and minimize side effects.

Other examples of palliative care for mesothelioma include:

• Draining fluid buildup from the pleural or peritoneal cavity
• Reducing chest or abdominal pressure
• Supporting the patient’s psychosocial needs

Clinical trials for mesothelioma offer patients the opportunity to undergo emerging treatment options that may not yet be FDA-approved. Patients with biphasic mesothelioma may be eligible to enroll in clinical trials focusing on surgery, immunotherapy, chemotherapy, radiation, multimodal therapy combinations and more novel therapies such as oncolytic viruses and gene therapies.

There are open clinical trials accepting patients with biphasic mesothelioma. Many clinical trials for mesothelioma welcome patients with all cell types, while others may limit enrollment to just one specific cell type, such as epithelioid mesothelioma.

While biphasic mesothelioma involves a combination of cell types, patients with a majority of epithelioid cells may be eligible to enroll in an epithelioid-focused clinical trial or vice versa. Most clinical trials accept patients with biphasic mesothelioma.