Every year, the National Comprehensive Cancer Network (NCCN) releases new Clinical Practice Guidelines in Oncology that report recent studies and research on specific types of cancer, including mesothelioma.
Recently, the NCCN issued its 2024 revised treatment guidelines for pleural mesothelioma, an aggressive type of cancer that forms in the lining of the lungs.
The updated NCCN guidelines emphasize the need for timely diagnosis and enhanced treatment options, including multimodal and systemic (whole-body) therapy, to improve the medical care and survival outcomes of mesothelioma patients.
Here are 5 key takeaways from the latest NCCN mesothelioma treatment guidelines.
1. Make Sure You Get an Accurate Diagnosis
The revised NCCN treatment guidelines emphasize the importance of getting an accurate mesothelioma diagnosis.
When doctors suspect mesothelioma, they examine tissue samples from the affected areas under a microscope to confirm the diagnosis and determine the type of mesothelioma cells present.
Doctors classify mesothelioma cells into three types:
- Epithelioid mesothelioma, the most common type that offers the best prognosis (health outlook) since the cells don’t spread as quickly
- Sarcomatoid mesothelioma, the hardest cell type to treat and also the most aggressive
- Biphasic mesothelioma, a combination of both of the other two cell types
Identifying the correct cell type is crucial because it helps doctors develop the most effective treatment plan for each patient.
The best way to get an accurate diagnosis is to see a doctor who specializes in mesothelioma. Use our Free Doctor Match to find top mesothelioma specialists near you.
2. Combine Multiple Treatments If Possible
In its revised guidelines, the NCCN recommends multimodal treatment for patients who qualify for surgery. Multimodal therapy combines more than one treatment method to target different aspects of the cancer.
If possible, patients should receive pre-surgery chemotherapy using either pemetrexed plus cisplatin or carboplatin. The NCCN malignant mesothelioma treatment guidelines further encourage patients to get trimodal therapy (three different treatments) if they’re able to.
A study published in Lung Cancer reported that combining chemotherapy, surgery, and radiation therapy led to an average pleural mesothelioma life expectancy of 20-29 months.
If a patient doesn’t opt for chemotherapy before surgery, the NCCN recommends a(n):
- Extrapleural pneumonectomy with chemotherapy after surgery and radiation therapy
- Pleurectomy/decortication with radiation therapy
3. Target the Entire Body If Surgery Isn’t an Option
Not every patient is eligible for surgery, depending on their overall health and stage of mesothelioma. In these cases, the NCCN recommends systemic therapy, which involves administering certain medications throughout the body to target cancer cells.
Systemic therapy is best for mesothelioma patients:
- Who don’t qualify for surgery or opt out of it
- Who have any cell type of stage 3 or stage 4 mesothelioma
- Who have any stage of sarcomatoid or biphasic mesothelioma
The goal of systemic therapy is to stop the spread of cancer cells and shrink existing tumors, even if they’ve already spread to multiple areas.
The NCCN recommends the following:
- Immunotherapy with nivolumab plus ipilimumab (Opdivo® and Yervoy®)
- Chemotherapy with cisplatin and pemetrexed plus the targeted therapy bevacizumab OR pemetrexed and carboplatin
A clinical trial showed that over 23% of patients who took Opdivo and Yervoy were still alive after 3 years.
Download our Free Immunotherapy Guide to learn more about Opdivo, Yervoy, and other immunotherapies for mesothelioma.
4. Explore Second-Line Treatment or Subsequent Therapies
Historically, research into second-line treatments, also known as subsequent therapies, has been limited. However, recent studies suggest promising second-line options for patients with pleural mesothelioma.
The NCCN specifically recommends these secondary therapies based on clinical trial data:
- Chemotherapy: If Opdivo and Yervoy was used as a first-line treatment, subsequent therapy options include pemetrexed, cisplatin/pemetrexed (with or without bevacizumab), or gemcitabine with ramucirumab.
- Opdivo with or without Yervoy: For patients who received chemotherapy as a first-line treatment, the NCCN recommends using Opdivo alone or in combination with Yervoy as a preferred subsequent therapy.
- Second round of pemetrexed: If patients responded well to first-line pemetrexed treatment, the NCCN suggests another round of a pemetrexed-based protocol.
In cases where mesothelioma returns after initial treatment, it’s advised to use single drugs like vinorelbine or gemcitabine or combine gemcitabine with ramucirumab.
These treatment options are applicable for recurring mesothelioma as well as cases involving the heart and testicles, providing new approaches to managing the disease if it returns.
5. Look for Mesothelioma Clinical Trials
The NCCN encourages patients to participate in studies because “the best management of any patient with cancer is in a clinical trial.” Trials also help to move research into new treatments forward.
By joining a mesothelioma clinical trial, patients may be able to:
- Take advantage of new treatments at no cost to them
- Improve their prognosis and life expectancy
- Contribute to the field of mesothelioma research
- Help doctors someday find a cure for this devastating cancer
Wondering if mesothelioma clinical trials may be right for you? Call us at (866) 608-8933 now for help finding active trials in your area.
Get Help Finding the Right Treatment
At Mesothelioma Hope, our Patient Advocates can listen to your story and help you understand your diagnosis, symptoms, treatment options, and next steps.
“My foremost priority is ensuring patients grasp their diagnosis, empowering them to make informed health care decisions.”
Wherever you or your loved one is in their mesothelioma journey, we are here to help, from finding the right doctor to pursuing compensation for treatment.
Contact our team of caring Patient Advocates now. It’s always free to speak with us.
