The American Society of Clinical Oncology (ASCO) recently released updated guidelines for treating pleural mesothelioma, a cancer that affects the lung's lining. Since the 2018 guidelines, there have been notable advancements in managing the disease. The latest update emphasizes four key areas: the role of surgery, new systemic treatments, changes regarding pathology, and germline testing. These guidelines aim to assist healthcare providers in delivering optimal care to patients with this rare cancer. Below, we explore these four areas.
- The Role of Surgery
Per the updated guidelines, surgical procedures should be more selective and not routinely offered to all patients, as has been the case previously. The updated guidelines recommend surgical intervention primarily for patients with early-stage epithelioid mesothelioma. Surgery should be considered only for carefully chosen patients with promising prognostic factors, such as those with early-stage epithelioid mesothelioma who have undergone thorough staging. Ideally, these patients should receive treatment at specialized centers known for low complication and mortality rates. Additionally, surgery should be part of a comprehensive, multimodal treatment approach and, when possible, conducted within clinical trials to ensure the best outcomes. Doublet immunotherapy should be offered as a first-line systemic treatment option in patients with newly diagnosed pleural mesothelioma.
- New Systemic Treatments
Systemic treatments are designed to target cancer cells throughout the body. They are used in mesothelioma treatment because the cancer cells can spread to different areas, but this treatment can circulate where the cancer cells might be. The ASCO guidelines recommend that for patients with epithelioid mesothelioma, a chemotherapy combination that includes pemetrexed and a platinum-based drug (with or without bevacizumab) remains a key treatment option and should be offered as a first-line therapy. However, for patients with non-epithelioid mesothelioma, this chemotherapy is generally not recommended unless they are unable to receive immunotherapy due to medical reasons. Additionally, continuing pemetrexed chemotherapy after completing the initial treatment is not advised.
- Pathologic Insights
Concerning mesothelioma pathology, the term "malignant mesothelioma" has been simplified to "mesothelioma," as the disease is now considered malignant/cancerous. Now, mesothelioma must be reported as epithelioid, sarcomatoid, or biphasic because each type provides essential insights into prognosis and treatment options. Identifying the specific subtype will aid in determining whether chemotherapy or immunotherapy is the most effective treatment approach.
Additionally, doctors have recently identified a premalignant condition called mesothelioma in situ, which is considered an early warning stage of mesothelioma. It can be found in patients with long-standing pleural effusions (a fluid buildup around the lungs) for a long time. If a doctor suspects this condition, additional tests, such as BAP1 and MTAP protein testing, should be done to confirm the diagnosis.
- Germline Testing
The updated guidelines recommend germline testing for all mesothelioma patients. The research found that pleural mesothelioma patients with inherited BAP1 gene mutations tend to respond better to platinum-based chemotherapy, with an average survival of 7.9 years compared to 2.4 years for those without the mutation, hence the recommendation.
As research advances, mesothelioma treatment also improves, giving patients more hope. With these updated guidelines, patients can expect to receive the most effective treatments based on their unique condition.
Arizona Mesothelioma Lawyers
If you or a loved one were diagnosed with mesothelioma, contact our office to speak to one of our experienced Arizona mesothelioma attorneys about your situation. Our office can help investigate your case and determine if compensation can be sought from negligent parties to help you live a more comfortable life.
