Although the disease malignant pleural mesothelioma has been known and treated for decades, especially among shipyard workers and U. S. Navy veterans, pleural mesothelioma practice guidelines were first presented only recently, in March 2010, by Dr. Lee Krug, director of the Mesothelioma Program at Memorial Sloan-Kettering at the annual meeting of the National Comprehensive Cancer Network (NCCN). The Malignant Pleural Mesothelioma practice guidelines encompass diagnosis and evaluation, treatment for the various stages of mesothelioma, chemotherapy, surgery and radiation therapy. These guidelines serve as a practical outline for physicians faced with diagnosing and treating a patient with pleural mesothelioma. The guidelines were developed through the collaborative effort of the NCCN Malignant Pleural Mesothelioma panel members. The National Comprehensive Cancer Network is a nonprofit alliance comprised of more than 20 of the leading cancer treatment centers across the country.
Mesothelioma Surgery as a Viable Option
Dr. Krug in his presentation discussed surgery as an option for treating malignant pleural mesothelioma. There are two types of surgeries; one is the decortication or pleurectomy and the other is the more aggressive approach which is the extrapleural pneumonectomy (EPP). The extrapleural pneumonectomy involves resecting the pleura, the lung and the diaphragm. This is a major surgery and should be performed by skilled surgeons, he remarked. Dr. Krug indicated that the extrapleural pneumonectomy should be considered for patients with early stage mesothelioma. He indicated there is a fair amount of controversy in the medical community about its use.
At the International Mesothelioma Program (IMP) at Brigham and Women’s Hospital, one of the member institutions of the NCCN, Dr. David Sugarbaker regularly and skillfully performs both surgeries with some remarkable results.
Chemotherapy and Radiation Therapy Necessary for Mesothelioma
The guidelines indicate that the first line chemotherapy regimen is pemetrexed (Alimta) combined with Cisplatin. Even with surgery, both chemotherapy and radiation therapy are recommended. Carboplatin can also be used in place of Cisplatin. Use of other drugs such as Gemcitabine and Vinorelbine can be prescribed as well. Chemotherapy and radiation are necessary to prevent relapse and to treat the cancer cells that are microscopic and are present even after surgery.
Mesothelioma Guidelines Will Improve Treatment
The oncology practice guidelines are a result of evidence based research and are the consensus of the malignant mesothelioma panel of NCCN. Thirty-five oncologists, surgical oncologists, radiation oncologists, pathologists and hematology oncologists participated on the panel and worked on the guidelines. The guidelines are now available for practicing physicians, but of course each physician will use his or her best independent medical judgment to decide how to treat and care for a mesothelioma patient.
These unprecedented malignant pleural mesothelioma guidelines take medical care a big step forward in standardizing and improving the treatment, prognosis and quality of life for a person being diagnosed with mesothelioma today. Attorney Ilana Waxman is the managing partner of Galiher DeRobertis Waxman, a law firm that has represented mesothelioma clients for over 35 years. She applauds and commends the work of the many physicians and scientists in their clinics, hospitals and laboratories:
“It is their hard work and years of experience that enabled the NCCN to develop these new clinical practice guidelines for malignant pleural mesothelioma.”