Two studies out of Australia and Japan have underscored the safety and effectiveness for widely-used treatments mesothelioma symptoms and the cancer itself, further reinforcing them as effective ‘gold standards’ in a field with few true beacons of hope for mesothelioma patients. This means that late-stage mesothelioma patients can rely on indwelling pleural catheters to remedy pleural effusion with relative safety, while patients facing chemotherapy have further reason to hope for the effectiveness of Cisplatin-Alimta (pemetrexed) drug cocktails.
Pleural Effusion-Managing Catheters Not A Significant Risk For Metastasis
One of the most common and life-limiting symptoms for pleural mesothelioma patients is known as pleural effusion, a fluid buildup in the lining around the lungs. Left untreated, pleural effusion can trigger shortness of breath, severe chest pain, coughing, and other undesirable problems.
So far, the solution to pleural effusion has been either pleurodesis, which fuses the lining together in order to block fluid from building up, or installation of a catheter into the space in order to drain off the fluid. Since not all patients are candidates for the sometimes-risky pleurodesis procedure, the availability of catheters has proved to be an effective recourse for many, even if it carries its own risks.
The most serious risk associated with the so-called indwelling pleural catheters, or IPCs, has been considered to be the risk that the pleural mesothelioma will spread along the catheter pathway. Some studies indicate more than 6% of patients with IPCs will experience this problem.
A new Australian study, published in the journal Chest, indicates that, while the issue is still of clinical concern, the practical effects are mild and manageable. Symptoms tend to be mild, while the metastasized cancer tends to respond well to radiotherapeutic treatment.
The study looked at 107 patients who had either pleural mesothelioma or another pleural-effusion-causing metastatic cancer. According to the study results, metastatic cancer appeared in 10% of cases, 9 mesothelioma patients and 2 patients with other cancer. It generally appeared quite late, a median 280 days following catheter insertion, and the longer the elapsed time the greater the risk of mesothelioma at the cancer site.
However, palliative radiotherapy aimed at the metastatic mesothelioma was used with six of those subjects, and it was effective and well-tolerated. The symptoms were mild and the cancer responded well, and the radiotherapy was possible to administer without removing the catheter.
Standard Chemotherapy Still The Best Mesothelioma Treatment
While 90 percent of mesothelioma patients will eventually develop pleural effusion which could make them a candidate for the catheter procedure, Japanese researchers have concluded the best way to help earlier-stage mesothelioma patients remains the popular combination of cisplatin with Alimta (pemetrexed).
Publishing in the journal Respiratory Investigations, the Japanese team found that Alimta produced better long term results against mesothelioma than Gemzar (gemcitabine) when combined with cisplatin. (Some studies have found Gemzar, a nucleoside analog, to be a promising alternative.)
Studying 30 consecutive pleural mesothelioma patients between July 2002 and December 2011, they found that 35% of the 17 Alimta and cisplatin-treated patients responded, while only 15% of the 13 Gemzar and cisplatin-treated patients responded to therapy. The long term results were also favorable: Alimta-treated patients had a longer median survival (a year and 7 months, vs about 10 months) and less frequent and less severe side effects.
Both Gemzar and Alimta are chemotherapy drugs marketed by the same firm, Eli Lilly and Company.
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