A Rare Cancer: Malignant Mesothelioma
A discussion on the therapies, research and the future of treatments for a type of cancer that accounts for 3,000 diagnoses per year, 80% of which are due to asbestos exposure.
Malignant mesothelioma is a cancer that affects the thin tissue on the inside of the lungs, chest wall and abdomen. While only 3,000 cases are diagnosed in the U.S. per year, the five-year survival rate for pleural mesothelioma of the lung tissue, which is the most common kind, is only 12%, according to the American Cancer Society.
It’s also an ongoing international problem, one that Sylvester Comprehensive Cancer Center, part of UHealth – the University of Miami Health System, is tackling.
Majority of Mesothelioma Patients Exposed to Asbestos
About 80% of all malignant mesothelioma cases are caused by exposure to asbestos, and “there are still parts of the world where people are exposed to asbestos because there’s no regulation,” said Estelamari Rodriguez, M.D., M.P.H., clinical research lead for the thoracic site disease group and associate director of community outreach at Sylvester.
While smoking hasn’t been linked directly to malignant mesothelioma, it is a factor when a person has been exposed to asbestos.
Sylvester is a leader in how to care for patients with this kind of cancer and in the development of medical interventions for the disease, including surgery, to offer hope where for so long, there has been none.
As such, Sylvester recently hosted the second Miami International Mesothelioma Symposium. The virtual event brought international experts together from different specialties to discuss the global burden of the disease, new treatment options like advancements in immunotherapy, chemotherapy and radiation, and surgical options. They discussed the role of supportive care and rehabilitation in the management of the disease.
“We brought all the specialties together to share what we are doing here, and where we’re going next,” Dr. Rodriguez said.
Sylvester is working to reduce the disparities in outcomes among mesothelioma patients. The team is also reaching out to South Florida communities to educate them about Sylvester’s mesothelioma program, including its clinical trials and immunotherapy options.
New Treatment Options for an Aggressive Cancer
Patients coming to Sylvester are a mix of people exposed in other countries and people who were exposed in the U.S. decades ago.
“We want to be ready to offer them the most aggressive treatment up front,” Dr. Rodriguez said.
Catching a case early is key, though that can be difficult. There is often a long lead time between exposure and cancer symptoms.
“There are veterans who were exposed in Navy yards, with tobacco exposure, but don’t present until decades later,” Dr. Rodriguez said.
She’s also seen patients in their 30s and 40s who were most likely exposed to asbestos in their homes.
These patients are also often initially misdiagnosed with fluid in the lung. Even if the fluid is removed, no one knows what it really is.
“It’s important for people to recognize the symptoms of mesothelioma, even though it’s rare,” Dr. Rodriguez said, adding that patients benefit from a multidisciplinary approach. “We must have a whole team of people that care about doing this well.”
Multidisciplinary Approach to Mesothelioma Care
The team creates a multidisciplinary approach, with radiation, chemotherapy and surgery as treatment options. Surgery patients may have cancerous sections of their pleura, diaphragm, and/or pericardium removed. These surgeries may also include neoadjuvant therapy—chemotherapy designed to shrink tumors before a procedure to make it less invasive and more effective—and adjuvant heated intraoperative chemotherapy, which reduces the risk of tumors coming back.
Patients with advanced mesothelioma may also undergo surgery to alleviate symptoms and discomfort, such as to make breathing easier.
Select patients may also be eligible for pleurectomy decortication, which removes the pleural lining around the lung and tumors and fibrous tissue from the lung. It’s a rare surgery because complications can be high, but one done by Nestor R. Villamizar, M.D., Sylvester researcher, associate program director of the Cardiothoracic Surgery Residency program and associate professor of surgery at the Miller School.
“The patient has to have the reserve to tolerate this operation,” Dr. Villamizar said.
Still, he said, it can be worth trying for a select number of patients who are young and otherwise healthy, as long as they know the risks.
Sylvester is also involved in clinical trials for CAR T-cell therapy treatment, which involves T cells that are genetically altered to attack their own cancer. Such treatments have been approved for certain blood cancers, leukemias and multiple myeloma. Hopefully, Dr. Rodriguez said, they will work and be approved for malignant mesothelioma, too.
“Our approach is for multidisciplinary care to be aggressive up front,” said Dr. Rodriguez. “This is not something an oncologist can treat alone. Through different specialists, we can get these patients to their best outcomes.”