Mesothelioma cancer is one of the cancer which occurs to the chest and lung cavity. It is the rare cancer which is found. Is you or someone suffering from it? Want to get rid from it then here is the accurate cure for it with no side effects. More information meets: dr jack Mesothelioma cancer is one the rare form of cancer in which the cells are found in the chest or the lung cavity. In this disease the cells become abnormal and divide without control or order. This cancer cells spread to the nearby tissues and organs of the nearby parts of the body. This is the disease caused as a result of malignant cancerous cells lining the patient's body cavities such as chest, abdominal region or the area surrounding the heart. It is very difficult to assess consistently due to the great variability in time before diagnosis and the rate of progression of malignant mesothelioma.
The people who are exposed to asbestos that is their working area or the environment in which they are living are at higher risk of getting this cancer. This disease in many cases does not occur for decades after the exposure to the cancer causing substances. It is also said that all of us are exposed to this disease that is in the air we breath, water we drink, from the natural deposits in the earth and the asbestos products around us.
The manufacturers of this asbestos product owners were prosper as they got much income to them. But the workers who worked for it had to ultimately suffer for it. Though the government took actions against this asbestos production and banned the usage of these products but yet it is still used, imported and making the people to get higher risk at their lives. So, to stop the people to getting addicted from this disease it is an urge need that the awareness should be given to the people about this asbestos and the effects of it as it turns them to the attack of mesothelioma cancer.
Smoking is also one of the risk for contracting mesothelioma cancer in the people. This also is one of the cause for the development of cancer in the body. We cannot find any of the earliest symptoms are less serious illness and they are neglected. In some cases this cancer does not show the signs of the sickness in the early stages of the development of the disease.
The most common symptoms are dyspnea, pleuritic pain, lasting cough, fatigue, shortness or difficult in breath, chest pain, chronic or persistent coughs and weight loss. This disease is more found in men than women. This occurs in the people who are above the age of 30 years that is after the initial exposure to asbestos. But it should be treated in its initial stage as early as possible so that it may not go deeper.
The major cause of this disease is the people working with asbestos. During the production of the asbestos products if the tiny particles of it are inhaled or swallowed then this causes serious health problems which in turn lead to mesothelioma cancer. But there are few cases that are reported without any known exposure to asbestos. If we are more exposed to asbestos then this can lead us to lung cancer, chronic lung ailment, other cancers like larynx and kidney.
The faster you consult the doctor or the specialist it would be better to get specialized care for getting better and coming out of it to lead a normal life. So, it is the primary or the basic need to get more information and cure the disease. Many cancer treatment options are not very effective in treating mesothelioma. But at our center we provide you the treatment to reduce the cancer and free you from the suffering from our specialist with the medication which are natural and no side effects. Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Sometimes, these treatments are combined.
by : dr jack
Dr Jack is a Conventionally Trained Western Medical Doctor from India and fellow of American Academy of Pediatrics (AAP). He is also trained in traditional supplements since the age of 5 years to practice complimentary alternate supplements. More information: dr jack
Friday, December 8, 2006
Mesothelioma Treatment & Information
Getting credible information about the diagnosis of Mesothelioma, is very important for patients and their love ones. Mesothelioma is an asbestos-related cancer of the lung, or known as the pleura which may cause a patient to become short of breath because they have been exposed to asbestos. Every case is different and sometimes a patient may not show any symptoms at all. Mesothelioma consists of several forms. Pleural Mesothelioma is one of the forms and are cancer cells found in the lining of the abdominal cavity or found in the lining around the heart. This form of cancer can be painful because it can spread through the entire body and cause the organs to shut down. Workers who have been exposed to asbestos do not all contract Pleural Mesothelioma cancer. This cancer could be related to asbestos exposure and not all asbestos exposure is harmful. Asbestos may already be fixated in the walls not causing the particles to be free in the air, effecting workers.
When there are free particles in the air, the workers are exposed to asbestos and that is harmful to the worker and may cause the worker to contract Pleural Mesothelioma. A second form of the cancer is Peritoneal Mesothelioma, which is a rare form of cancer that affects the lining of the abdomen. This cancer is also associated with asbestos exposure and occurs in the tissue lining of the abdominal cavity, which contains fluid that enables the organs to move and work right. Peritoneal Mesothelioma is the most common cancer that is related to asbestos exposure because it is the place where the cancer spreads. This cancer can cause severe health problems and complications for a patient. Normally a patient may experience flu symptoms as well as the swelling of the abdomen. Pericardial Mesothelioma caused from asbestos is another form of cancer, which is also rare affecting the lining surrounding the heart. Pericardium are the cells that produce lubricating fluids which protects the heart allowing the heart to move freely when pumping blood into the other parts of the body. This can cause a patient to have cancer spread through the tissues in the lining of the heart. At this stage, treatments may not be effective and may lead to fatal circumstances.
It may take a patient a long time after being exposed to asbestos, before he or she recognizes symptoms such as chest pain, breathing problems and a continuous cough. Being diagnosed is the first step and even though it can be extremely difficult to detect Mesothelioma symptoms because they are similar to so many other types of cancers your doctor will perform a physical exam and ask you about your exposure to asbestos. Several tests will be done, including chest x-rays, MRI scans or CT scans to determine any abnormal changes. A tissue sample may be obtained to confirm the diagnosis and if your doctor has concluded that you are a patient of Mesothelioma your next step is treatment. Therapy is a form of treatment and there are several kinds of therapies to choose from. Do not be afraid, you are not alone; support is out there to help you fight the cancer and get the treatment you deserve. Please visit www.mesothelioma-treatment-2day.com for more information on mesothelioma and treatment options.
by : Stephanie Guindon
Webmaster of Mesothelioma Treatment & Information
When there are free particles in the air, the workers are exposed to asbestos and that is harmful to the worker and may cause the worker to contract Pleural Mesothelioma. A second form of the cancer is Peritoneal Mesothelioma, which is a rare form of cancer that affects the lining of the abdomen. This cancer is also associated with asbestos exposure and occurs in the tissue lining of the abdominal cavity, which contains fluid that enables the organs to move and work right. Peritoneal Mesothelioma is the most common cancer that is related to asbestos exposure because it is the place where the cancer spreads. This cancer can cause severe health problems and complications for a patient. Normally a patient may experience flu symptoms as well as the swelling of the abdomen. Pericardial Mesothelioma caused from asbestos is another form of cancer, which is also rare affecting the lining surrounding the heart. Pericardium are the cells that produce lubricating fluids which protects the heart allowing the heart to move freely when pumping blood into the other parts of the body. This can cause a patient to have cancer spread through the tissues in the lining of the heart. At this stage, treatments may not be effective and may lead to fatal circumstances.
It may take a patient a long time after being exposed to asbestos, before he or she recognizes symptoms such as chest pain, breathing problems and a continuous cough. Being diagnosed is the first step and even though it can be extremely difficult to detect Mesothelioma symptoms because they are similar to so many other types of cancers your doctor will perform a physical exam and ask you about your exposure to asbestos. Several tests will be done, including chest x-rays, MRI scans or CT scans to determine any abnormal changes. A tissue sample may be obtained to confirm the diagnosis and if your doctor has concluded that you are a patient of Mesothelioma your next step is treatment. Therapy is a form of treatment and there are several kinds of therapies to choose from. Do not be afraid, you are not alone; support is out there to help you fight the cancer and get the treatment you deserve. Please visit www.mesothelioma-treatment-2day.com for more information on mesothelioma and treatment options.
by : Stephanie Guindon
Webmaster of Mesothelioma Treatment & Information
What Treatment Option Could be Work on Mesothelioma?
Mesothelioma is a Cancer that attacks the lining of the lungs and has a direct link to people who have come into direct contact with asbestos.Some symptoms of this cancer are shortness of breath, pain in the chest or under the ribcage, an abdominal lump or swelling, fever and unexplained weight loss.
The people that are most likely to suffer from mesothelioma are those who were exposed to asbestos fibers at work.Asbestos have been exploited for a variety of purposes, such as industrial products, roof shingles and flooring products.
And Treatment options could be work on Mesothelioma : 1.Radiation is prescribed aggressively for mesothelioma patients and is often given in combination with surgery or in order to control symptoms and uses high-energy x-rays to kill cancer cells and shrink tumors. 2.Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy.
3.Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein. Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen. People affected by Mesothelioma can file lawsuits against asbestos makers, manufacturers and employers as they have the duty to protect their workers from the negative effects of asbestos including Mesothelioma.
by : Jack Ford
Jack Ford is a Asbestos and Mesothelioma writer & useful information. For more info visit http://www.MesotheliomaClue.Com
The people that are most likely to suffer from mesothelioma are those who were exposed to asbestos fibers at work.Asbestos have been exploited for a variety of purposes, such as industrial products, roof shingles and flooring products.
And Treatment options could be work on Mesothelioma : 1.Radiation is prescribed aggressively for mesothelioma patients and is often given in combination with surgery or in order to control symptoms and uses high-energy x-rays to kill cancer cells and shrink tumors. 2.Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy.
3.Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein. Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen. People affected by Mesothelioma can file lawsuits against asbestos makers, manufacturers and employers as they have the duty to protect their workers from the negative effects of asbestos including Mesothelioma.
by : Jack Ford
Jack Ford is a Asbestos and Mesothelioma writer & useful information. For more info visit http://www.MesotheliomaClue.Com
Mesothelioma Cancer Treatment - Asbestos Kills
Mesothelioma cancer is a disease that results from exposure to asbestos related substances. Asbestos usually consists of fibres that can enter the body through the mouth, or the skin, and, subsequently, enter the lungs, or blood stream.
Mesothelioma cancer has become more widely documented in the last 5-10 years, due to the fact that symptoms of asbestos cancer can take between 20 to 40 years to manifest. Mesothelioma cancer is hard to diagnose, as the symptoms do not tend to manifest themselves until the later stages of the disease. Symptoms of mesothelioma lung cancer include shortness of breath, chest pain, fever and other secondary illnesses such as pneumonia.
Asbestos cancer most often develops in men between the ages of 50 to 70 years who were exposed to high levels of asbestos in the workplace. Asbestos was mainly used in manufacturing industries such as automotive and ship building as well as in the construction industry. The use of asbestos was only recently banned in the 1990's.
Mesthelioma lung cancer has been found to be the most common form of mesothelioma cancer and it develops in the lining of the lung (pleural). Mesothelioma cancer can also develop in the abdominal area (peritoneal) and around the heart (pericardial). There is a greater chance of malignancy in abdominal asbestos cancer. For a more detailed explanation of mesothelioma cancer, visit http://www.lung-canceradvice.com
Mesothelioma lung cancer can be detected through a CT scan which enables it to be sometimes diagnosed earlier than the other two types of mesothelioma cancer. The type of mesothelioma cancer treatment will depend on the stage at which the cancer was diagnosed, the age of the patient as well as personal preferences. The disease can be divided into four separate stages. The stage in the disease process that is reached will determine the method of mesothelioma cancer treatment. At the first stage when the tumour is confined to the lining of the lungs, surgeons may try to remove the entire tumour surgically. Once the tumour has invaded the surrounding body tissues in the later stages, it is not curable.
Conventionally, the more advanced stages of mesothelioma cancer are treated with either radiation therapy or chemotherapy. Radiation therapy utilizes high-energy x-rays to destroy cancerous cells and shrink tumours Chemotherapy, on the other hand, uses drugs to destroy cancer cells. The aim of these mesothelioma cancer treatments is to prolong the patient's life as the disease cannot be cured in the more advanced stages.
In addition to these conventional mesothelioma cancer treatments, there are also various experimental treatments currently under investigation which offer new hope.
Immunotherapy: This form of biological therapy for mesothelioma cancer treatment uses the patient's own immune system to attack the cancerous cells. Clinical studies have shown that the immune system is able to distinguish healthy cells from cancer cells, and can therefore be used to destroy those cancerous cells.
Gene Therapy: This form of mesothelioma cancer treatment is very much still in the developmental stages. The process involves injecting a specific gene straight into the tumour. This gene renders the cancer cells sensitive to the antiviral drug glanciclovir which under normal circumstances is not effective against these cells. The glanciclovir is then able to destroy all the cancer cells without harming the healthy tissue cells.
Drug Therapy: The drug Alimta is the only chemotherapy drug to be approved by the Food and Drug Administration (FDA)for the treatment of patients with malignant mesothelioma lung cancer . This new and exciting drug has been demonstrated in clinical trials to reduce symptoms and increase the life expectancy of patients.
Photodynamic Therapy: Photodynamic therapy involves the use of light to destroy cancer cells. The patient first is first administered a photosensitizing drug that only collects in cancerous cells. Fibre-optic cables are then inserted in the body in order to focus light of a certain frequency on the tumour. The light stimulates the photosensitizing drug to produce toxic oxygen molecules that destroy the cancerous cells.
These experimental mesothelioma cancer treatments, although still in the developmental stages, offer cancer victims the prospect of a better and longer life. With the likelihood of an increase in the number of people diagnosed with asbestos cancer, further research into other forms of mesothelioma cancer treatment is vital.
by : Gregory De Villiers
The author, Gregory De Villiers, writes on a variety of health and wellness topics. For more information on mesothelioma cancer as well as asbestos litigation, visit http://www.lung-canceradvice.com
Mesothelioma cancer has become more widely documented in the last 5-10 years, due to the fact that symptoms of asbestos cancer can take between 20 to 40 years to manifest. Mesothelioma cancer is hard to diagnose, as the symptoms do not tend to manifest themselves until the later stages of the disease. Symptoms of mesothelioma lung cancer include shortness of breath, chest pain, fever and other secondary illnesses such as pneumonia.
Asbestos cancer most often develops in men between the ages of 50 to 70 years who were exposed to high levels of asbestos in the workplace. Asbestos was mainly used in manufacturing industries such as automotive and ship building as well as in the construction industry. The use of asbestos was only recently banned in the 1990's.
Mesthelioma lung cancer has been found to be the most common form of mesothelioma cancer and it develops in the lining of the lung (pleural). Mesothelioma cancer can also develop in the abdominal area (peritoneal) and around the heart (pericardial). There is a greater chance of malignancy in abdominal asbestos cancer. For a more detailed explanation of mesothelioma cancer, visit http://www.lung-canceradvice.com
Mesothelioma lung cancer can be detected through a CT scan which enables it to be sometimes diagnosed earlier than the other two types of mesothelioma cancer. The type of mesothelioma cancer treatment will depend on the stage at which the cancer was diagnosed, the age of the patient as well as personal preferences. The disease can be divided into four separate stages. The stage in the disease process that is reached will determine the method of mesothelioma cancer treatment. At the first stage when the tumour is confined to the lining of the lungs, surgeons may try to remove the entire tumour surgically. Once the tumour has invaded the surrounding body tissues in the later stages, it is not curable.
Conventionally, the more advanced stages of mesothelioma cancer are treated with either radiation therapy or chemotherapy. Radiation therapy utilizes high-energy x-rays to destroy cancerous cells and shrink tumours Chemotherapy, on the other hand, uses drugs to destroy cancer cells. The aim of these mesothelioma cancer treatments is to prolong the patient's life as the disease cannot be cured in the more advanced stages.
In addition to these conventional mesothelioma cancer treatments, there are also various experimental treatments currently under investigation which offer new hope.
Immunotherapy: This form of biological therapy for mesothelioma cancer treatment uses the patient's own immune system to attack the cancerous cells. Clinical studies have shown that the immune system is able to distinguish healthy cells from cancer cells, and can therefore be used to destroy those cancerous cells.
Gene Therapy: This form of mesothelioma cancer treatment is very much still in the developmental stages. The process involves injecting a specific gene straight into the tumour. This gene renders the cancer cells sensitive to the antiviral drug glanciclovir which under normal circumstances is not effective against these cells. The glanciclovir is then able to destroy all the cancer cells without harming the healthy tissue cells.
Drug Therapy: The drug Alimta is the only chemotherapy drug to be approved by the Food and Drug Administration (FDA)for the treatment of patients with malignant mesothelioma lung cancer . This new and exciting drug has been demonstrated in clinical trials to reduce symptoms and increase the life expectancy of patients.
Photodynamic Therapy: Photodynamic therapy involves the use of light to destroy cancer cells. The patient first is first administered a photosensitizing drug that only collects in cancerous cells. Fibre-optic cables are then inserted in the body in order to focus light of a certain frequency on the tumour. The light stimulates the photosensitizing drug to produce toxic oxygen molecules that destroy the cancerous cells.
These experimental mesothelioma cancer treatments, although still in the developmental stages, offer cancer victims the prospect of a better and longer life. With the likelihood of an increase in the number of people diagnosed with asbestos cancer, further research into other forms of mesothelioma cancer treatment is vital.
by : Gregory De Villiers
The author, Gregory De Villiers, writes on a variety of health and wellness topics. For more information on mesothelioma cancer as well as asbestos litigation, visit http://www.lung-canceradvice.com
Common Treatments and Medical Procedures for a Mesothelioma Patient
Once a patient has been diagnosed with mesothelioma, both the doctor and the patient must then determine the best possible treatment. Mesothelioma prognosis, or the recovering factor for a patient, will vary based on several different characteristics:
1. Size of the mesothelioma
2. Whether or not the cancer is spreading
3. Where the mesothelioma is located
4. The patient's physical health condition and age
5. How the cells are portrayed under a microscope
Three Different Types of Mesothelioma Cells
1. Mixed Cell Type - This cell type is a mixture of the cancer cells and is normally labeled as an intermediate form of the cancer.
2. Epithelial Cell Type - These cells are the most treatable, and have the best prognosis.
3. Fibrosarcomatous Cell Type - This cell type is the worst type of mesothelioma, and has a negative prognosis.
How a Treatment is Selected
Treatments and procedures for mesothelioma are selected after considering the characteristics and cell types above. There are standard treatments, which have been tested on previous patient studies, and are most commonly used. There are also trials and/or experimental treatments that may be explored at the patient's or doctor's wishes.
Malignant Mesothelioma and Standard Treatments
The most common treatment of malignant mesothelioma is a surgery in which the doctor will remove part of the abdomen or chest lining and some tissue surrounding it. A lung may be removed or part of the diaphragm, based on how far the mesothelioma has spread. Removal of the lung is a procedure called "pneumonectomy." Radiation and/or chemotherapy are also a part of the standard treatments along with the surgery. Radiation kills off cancer cells using high-energy rays or x-rays. Chemotherapy kills cancer cells using drugs taken either by pill or needle injection. Each of these treatments will result in side effects, varying from one patient to the next.
Intraoperative Photodynamic Therapy
This is a type of treatment which utilizes light and drugs to kill the cancer cells during a surgical procedure. The goal of the surgery is to remove the cancer (as much as possible), and to shine alight on the pleura, killing additional cancer cells. Studies of this type of surgery are being performed on patients in the early stages of mesothelioma of the chest.
Clinical Tests
Occasionally a mesothelioma patient may be urged to participate in experimental treatment options, where the patient will be exposed to new ideas and procedures that are being developed. Oftentimes, traditional treatments will be combined with new tests to find more effective ways of fighting mesothelioma. These options are available for patients who may not be able to endure the standard treatments for health or physical reasons.
The earlier mesothelioma is detected in a patient, the better the prognosis. Each patient should be aware of all treatment options before making a decision, and also consult with a specialist to learn the best option for them.
by : Gust A. Lenglet
Gust A. Lenglet has been an accountant and financial advisor for many years. He is President and CEO of HBS Financial Group, Ltd. and offers online tax filing through his many web sites. He is also an accomplished author in the tax, legal, and education fields.
1. Size of the mesothelioma
2. Whether or not the cancer is spreading
3. Where the mesothelioma is located
4. The patient's physical health condition and age
5. How the cells are portrayed under a microscope
Three Different Types of Mesothelioma Cells
1. Mixed Cell Type - This cell type is a mixture of the cancer cells and is normally labeled as an intermediate form of the cancer.
2. Epithelial Cell Type - These cells are the most treatable, and have the best prognosis.
3. Fibrosarcomatous Cell Type - This cell type is the worst type of mesothelioma, and has a negative prognosis.
How a Treatment is Selected
Treatments and procedures for mesothelioma are selected after considering the characteristics and cell types above. There are standard treatments, which have been tested on previous patient studies, and are most commonly used. There are also trials and/or experimental treatments that may be explored at the patient's or doctor's wishes.
Malignant Mesothelioma and Standard Treatments
The most common treatment of malignant mesothelioma is a surgery in which the doctor will remove part of the abdomen or chest lining and some tissue surrounding it. A lung may be removed or part of the diaphragm, based on how far the mesothelioma has spread. Removal of the lung is a procedure called "pneumonectomy." Radiation and/or chemotherapy are also a part of the standard treatments along with the surgery. Radiation kills off cancer cells using high-energy rays or x-rays. Chemotherapy kills cancer cells using drugs taken either by pill or needle injection. Each of these treatments will result in side effects, varying from one patient to the next.
Intraoperative Photodynamic Therapy
This is a type of treatment which utilizes light and drugs to kill the cancer cells during a surgical procedure. The goal of the surgery is to remove the cancer (as much as possible), and to shine alight on the pleura, killing additional cancer cells. Studies of this type of surgery are being performed on patients in the early stages of mesothelioma of the chest.
Clinical Tests
Occasionally a mesothelioma patient may be urged to participate in experimental treatment options, where the patient will be exposed to new ideas and procedures that are being developed. Oftentimes, traditional treatments will be combined with new tests to find more effective ways of fighting mesothelioma. These options are available for patients who may not be able to endure the standard treatments for health or physical reasons.
The earlier mesothelioma is detected in a patient, the better the prognosis. Each patient should be aware of all treatment options before making a decision, and also consult with a specialist to learn the best option for them.
by : Gust A. Lenglet
Gust A. Lenglet has been an accountant and financial advisor for many years. He is President and CEO of HBS Financial Group, Ltd. and offers online tax filing through his many web sites. He is also an accomplished author in the tax, legal, and education fields.
Treatment of malignant mesothelioma with methotrexate and vinblastine, with or without platinum chemotherapy
Study objective: To determine the efficacy of methotrexate, vinblastine, and platinum chemotherapy in patients with diffuse unresectable malignant mesothelioma.
Design: Patients with histologically confirmed malignant mesothelioma were evaluated for treatment with methotrexate, vinblastine, and cisplatin chemotherapy. If the patient had preexisting hearing loss or neuropathy, or was significantly disabled (eg, spending greater than half of the day in bed or a chair), cisplatin therapy was withheld.
Setting: All patients were initially evaluated at the University of Washington Medical Center and received chemotherapy at the University of Washington or in the community.
Interventions: Between 1990 and 1994, 17 patients received this chemotherapy. Ten patients received cisplatin, 100 [mg/m.sup.2] IV on day 1, methotrexate, 30 [mg/m.sup.2] IV on days 8, 15, and 22, and vinblastine, 3 [mg/m.sup.2] IV on days 8, 15, and 22, in 28-day cycles. One patient had carboplatin substituted for cisplatin due to preexisting hearing loss. Six patients received weekly methotrexate and vinblastine at the same doses without platinum.
Measurements and results: Nine of the 17 (53%; 95% confidence interval [CI], 28 to 77%) patients responded, including two complete remissions, two partial remissions, and five regressions. Median time to progression is 8 months. The median survival time for all patients is 14 months. Projected 2-year survival is 35% (95% CI, 12 to 60%).
Conclusions: Although the number of the patients in this study is small, the response rate and projected 2-year survival of 35% are better than those typically reported for unresectable malignant mesothelioma. Further investigation is warranted in confirmatory trials.
Key words: carboplatin; chemotherapy; cisplatin; mesothelioma; methotrexate; vinblastine
Abbreviations: CI=confidence interval
Unresectable malignant mesothelioma is a uniformly fatal disease for which treatment is largely ineffective. Reported median survival times for patients who have unresectable mesothelioma are in the 6- to 12-month range.(1),(2),(3),(4),(5),(6) Phase 2 chemotherapy regimens tested in this disease have shown little benefit over supportive care alone,(1),(4),(7),(8) with response rates commonly less than 20%.
Since 1990, we have been treating patients with unresectable malignant mesothelioma with a combination of methotrexate and vinblastine, with or without cisplatin. This particular regimen was chosen because this combination had not been tested in mesothelioma (to our knowledge), and because of reports of the efficacy of weekly methotrexate and vinblastine in desmoid tumors and retroperitoneal fibromatosis.(9),(10) We combined these drugs with cisplatin, an agent with response rates in mesothelioma between 13% and 36% when used as a single agent.(11),(12),(13)
MATERIALS AND METHODS
This is a retrospective analysis of patients with malignant mesothelioma seen at the University of Washington Medical Center between 1990 and 1994, and treated with methotrexate and vinblastine, with or without platinum chemotherapy. All had histologically confirmed malignant mesothelioma, and all were deemed to have unresectable disease because of local invasion or poor overall condition. Patients were offered this chemotherapy program providing they had a creatinine concentration within normal limits, a granulocyte count of [1,500/mm.sup.3] or more, a bilirubin level of 2 mg/dL or less, a platelet count of more than [100,000/mm.sup.3], and a Karnofsky performance status of 50% or greater (ie, they were at least capable of self-care and were spending no more than 50% of the day in a chair or bed). Cisplatin was not employed in patients who had significant hearing loss, peripheral neuropathy, or borderline performance status.
Patients who were eligible for cisplatin received this drug at 100 [mg/m.sup.2] IV on day 1, with precisplatin and postcisplatin hydration and antiemetics. Patients treated at the University of Washington received dexamethasone and ondansetron as the primary antiemetics. They then received methotrexate at a dose of 30 [mg/m.sup.2] IV, and vinblastine at 3 [mg/m.sup.2] IV, on days 8, 15, and 22, in 28-day cycles. For patients with large pleural effusions, the starting dose of methotrexate was 15 [mg/m.sup.2], and was escalated up to 30 [mg/m.sup.2] providing no mucositis or cytopenias occurred. One patient with preexisting hearing loss received carboplatin in substitution for cisplatin at a dose of 235 [mg/m.sup.2]. Patients who were not eligible for platinum therapy received methotrexate and vinblastine alone on a weekly basis at the same doses. Doses were modified for hematologic, allergic, and neurologic toxic reactions.
Table 1--Patient Characteristics
In regards to known unfavorable prognostic factors in mesothelioma,(6),(8),(15),(16) 7 patients had thrombocytosis, 11 had 6 months or less of symptoms before diagnosis, and 9 patients had chest pain; 1 additional patient, who had peritoneal mesothelioma, had abdominal pain. Weight loss was documented in only nine patients, with a median weight loss of 4.5 kg.
Median follow-up for all patients was 12 months (range, 4.6 to 44 months). The ten patients who were treated with cisplatin, methotrexate, and vinblastine received a median of 5 monthly cycles of chemotherapy (range, 3 to 20+ months). The six patients who received only methotrexate and vinblastine received a median of 5 months (range, 3 to 12 months) of treatment, and the one patient receiving carboplatin, methotrexate, and vinblastine continues to receive therapy after receiving 8 months of treatment.
Response
All patients were evaluable for response. Four patients had bidimensionally measurable disease; of these, two had a partial remission. Of the 13 patients with evaluable disease, 2 had a complete remission and 5 had regressions. Overall response rate is 9 of 17 patients, or 53% (95% confidence interval [CI], 28 to 77%). Eight of the nine responders received three-drug therapy. The median time to progression (Fig 1) is 8 months (range, 4 to 20 months). Seven patients had stable disease, for a median duration of 5 months (range, 4 to 15 months). The median survival time of all patients is 14 months (Fig 2). Projected 2-year survival is 35% (95% CI, 12 to 60%).
Toxicity
Toxicity of the this regimen was as expected from these chemotherapy agents. There were no treatment-related deaths. One patient had vomiting requiring hospitalization (grade 4 toxicity), and three other patients had six to ten episodes of vomiting in a 24-h period (grade 3 toxicity). Myelosuppression was mild to moderate: three patients developed a neutrophil nadir of between 500 and [900/mm.sup.3], and one patient had a platelet count nadir of [49,000/mm.sup.3]. The myelosuppression lasted 2 weeks and resolved after holding the methotrexate and vinblastine for 1 week, then reducing the doses upon hematologic recovery. Other toxic reactions included one episode of methotrexate-induced pneumonitis and one of methotrexate-induced hepatitis, both of which were reversed by discontinuation of this drug therapy. Six patients developed moderate paresthesias and three developed tinnitus, necessitating discontinuation of cisplatin therapy in two patients and of vinblastine therapy in one.
DISCUSSION
This particular regimen was chosen because of reports of the efficacy of weekly methotrexate and vinblastine in desmoid tumors and retroperitoneal fibromatosis. Although desmoid tumors are histologically distinct from mesothelioma and technically benign, they share a similar pattern of locally aggressive, infiltrating spread. Methotrexate and vinblastine have a reported response rate in desmoid tumors of 72%.(9),(10) We combined these drugs with cisplatin, an agent with modest activity(11),(12),(13) in patients who we believed could tolerate the drug.
Although the number of patients in this analysis is small, we are encouraged by the results. The 53% response rate and projected 2-year survival of 35% for these patients with unresectable mesothelioma are better that those typically reported in phase 2 trials of chemotherapy, although we acknowledge that these results could be due to patient selection factors. The 18 to 77% CI for response overlaps with the response rates seen with single-agent cisplatin (13 to 36%). The small number of patients precludes determining if our response rate could be due to the platinum compound alone.
Many prognostic factors have been identified by multivariate analyses that are associated with a worse outcome for patients with malignant mesothelioma. These include the following: chest pain, age younger than 50 years, less than 6 months of chest pain (for pleural mesothelioma), performance status of 2 (unable to work, but ambulatory [greater than]50% of the day) or performance status greater than 2 (limited ability for self-care, confined to bed or chair [greater than]50% of the day), thrombocytosis of 400,000 or more, advanced stage, and asbestos exposure.(6),(8),(15),(16) We believe that it is unlikely that our results are explained by a preponderance of good prognostic factors, since most of our patients were older than 50 years, had chest pain as a predominant symptom, and had a less than 6-month duration of symptoms. Most (ten) of our patients had epithelial mesothelioma, which can have a relatively indolent course. Responses to treatment, however, were seen in patients having either epithelial (six of ten) or mixed (three of six) histologic type; the one patient with sarcomatoid mesothelioma had stable disease. Toxic reactions were moderate overall, as expected from these drugs.
Regression by comparison of serial CT scans was used as a measure of response in this analysis, as has been done in many phase 2 reports of mesothelioma response to treatment. Because mesothelioma typically infiltrates the pleura or peritoneum without producing a bidimensionally measurable mass, assessment can be difficult. We considered our patients to have had a regression if two different investigators agreed that there was a definite decrease in the tumor's size and no new lesions appeared for 8 weeks. In non-small cell lung cancer, regression carries the same prognostic implications as partial remission.(17)
Although the small number of patients and the retrospective nature of this study make it difficult to draw valid comparisons of subsets, we observed a differential response rate for patients receiving three-drug therapy compared with those receiving methotrexate and vinblastine alone. Of the 11 patients who received platinum, methotrexate, and vinblastine, 1 had a complete remission, 2 had partial remissions, and 5 had regressions (8 of 11 patients). Of the six receiving methotrexate and vinblastine alone, there was only one responder (a patient who had a complete remission). This differential response rate for the three-drug combination may be due to a synergistic effect among the three drugs or perhaps due to the platinum compound alone. Further investigation of the three-drug regimen is warranted in confirmatory trials.
REFERENCES
(1) Vogelzang NJ. Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 1992; 19:64-71
(2) Sridhar KS, Doria R, Raub WA, et al. New strategies are needed in diffuse malignant mesothelioma. Cancer 1992; 70:2960-79
(3) Branscheid D, Krysa S, Bauer E, et al. Diagnostic and therapeutic strategy in malignant pleural mesothelioma. Eur J Cardiothorac Surg 1991; 5:466-72
(4) Rusch VW. Diagnosis and treatment of pleural mesothelioma. Semin Surg Oncol 1990; 6:279-85
(5) Achatzy R, Beba W, Ritschler R, et al. The diagnosis, therapy and prognosis of diffuse mesothelioma. Eur J Cardiothorac Surg 1989; 3:445-47
(6) Ruffie P, Feld R, Minkin S, et al. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 1989; 7:1157-68
(7) Krarup-Hansen A, Hansen HH. Chemotherapy in malignant mesothelioma: a review. Cancer Chemother Pharmacol 1991; 28:319-30
(8) Alberts AS, Falkson G, Goedhals L, et al. Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers. J Clin Oncol 1988; 6:527-35
(9) Weiss A, Lackman R. Chemotherapy of desmoid tumors and fibromatosis [abstract]. Proc Am Soc Clin Oncol 1994; 13:401
(10) Weiss AJ, Lackman RD. Low-dose chemotherapy of desmoid tumors. Cancer 1989; 64:1192-94
(11) Zidar BL, Green S, Pierce HI, et al. A phase II evaluation of cisplatin in unresectable diffuse malignant mesothelioma: a South-west Oncology Group study. Invest New Drugs 1988; 6:223-26
(12) Planting AS, Schellens JH, Goey SH, et al. Weekly high dose cisplatin in malignant pleural mesothelioma. Ann Oncol 1994; 5:373-74
(13) Mintzer DM, Kelsen D, Frimmer D, et al. Phase II trial of high dose cisplatin in patients with malignant mesothelioma. Cancer Treat Rep 1985; 69:711-12
(14) Kalbfleish JD, Prentice RL. The statistical analysis of failure time data. New York: John Wiley & Sons, 1980; 10-6
(15) Antman K, Shemin R, Ryan L, et al. Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985. J Clin Oncol 1988; 6:147-53
(16) Chahinian AP, Pajak TF, Holland JF, et al. Diffuse malignant mesothelioma: prospective evaluation of 69 patients. Ann Intern Med 1982; 96:746-55
(17) Jett JR, Su JQ, Krook JE, et al. Measurable or assessable disease in lung cancer trials: does it matter? J Clin Oncol 1994; 12:2677-81
COPYRIGHT 1996 American College of Chest Physicians
COPYRIGHT 2004 Gale Group
by Karen J. Hunt, Gary Longton, Margaret A. Williams, Robert B. Livingston
Design: Patients with histologically confirmed malignant mesothelioma were evaluated for treatment with methotrexate, vinblastine, and cisplatin chemotherapy. If the patient had preexisting hearing loss or neuropathy, or was significantly disabled (eg, spending greater than half of the day in bed or a chair), cisplatin therapy was withheld.
Setting: All patients were initially evaluated at the University of Washington Medical Center and received chemotherapy at the University of Washington or in the community.
Interventions: Between 1990 and 1994, 17 patients received this chemotherapy. Ten patients received cisplatin, 100 [mg/m.sup.2] IV on day 1, methotrexate, 30 [mg/m.sup.2] IV on days 8, 15, and 22, and vinblastine, 3 [mg/m.sup.2] IV on days 8, 15, and 22, in 28-day cycles. One patient had carboplatin substituted for cisplatin due to preexisting hearing loss. Six patients received weekly methotrexate and vinblastine at the same doses without platinum.
Measurements and results: Nine of the 17 (53%; 95% confidence interval [CI], 28 to 77%) patients responded, including two complete remissions, two partial remissions, and five regressions. Median time to progression is 8 months. The median survival time for all patients is 14 months. Projected 2-year survival is 35% (95% CI, 12 to 60%).
Conclusions: Although the number of the patients in this study is small, the response rate and projected 2-year survival of 35% are better than those typically reported for unresectable malignant mesothelioma. Further investigation is warranted in confirmatory trials.
Key words: carboplatin; chemotherapy; cisplatin; mesothelioma; methotrexate; vinblastine
Abbreviations: CI=confidence interval
Unresectable malignant mesothelioma is a uniformly fatal disease for which treatment is largely ineffective. Reported median survival times for patients who have unresectable mesothelioma are in the 6- to 12-month range.(1),(2),(3),(4),(5),(6) Phase 2 chemotherapy regimens tested in this disease have shown little benefit over supportive care alone,(1),(4),(7),(8) with response rates commonly less than 20%.
Since 1990, we have been treating patients with unresectable malignant mesothelioma with a combination of methotrexate and vinblastine, with or without cisplatin. This particular regimen was chosen because this combination had not been tested in mesothelioma (to our knowledge), and because of reports of the efficacy of weekly methotrexate and vinblastine in desmoid tumors and retroperitoneal fibromatosis.(9),(10) We combined these drugs with cisplatin, an agent with response rates in mesothelioma between 13% and 36% when used as a single agent.(11),(12),(13)
MATERIALS AND METHODS
This is a retrospective analysis of patients with malignant mesothelioma seen at the University of Washington Medical Center between 1990 and 1994, and treated with methotrexate and vinblastine, with or without platinum chemotherapy. All had histologically confirmed malignant mesothelioma, and all were deemed to have unresectable disease because of local invasion or poor overall condition. Patients were offered this chemotherapy program providing they had a creatinine concentration within normal limits, a granulocyte count of [1,500/mm.sup.3] or more, a bilirubin level of 2 mg/dL or less, a platelet count of more than [100,000/mm.sup.3], and a Karnofsky performance status of 50% or greater (ie, they were at least capable of self-care and were spending no more than 50% of the day in a chair or bed). Cisplatin was not employed in patients who had significant hearing loss, peripheral neuropathy, or borderline performance status.
Patients who were eligible for cisplatin received this drug at 100 [mg/m.sup.2] IV on day 1, with precisplatin and postcisplatin hydration and antiemetics. Patients treated at the University of Washington received dexamethasone and ondansetron as the primary antiemetics. They then received methotrexate at a dose of 30 [mg/m.sup.2] IV, and vinblastine at 3 [mg/m.sup.2] IV, on days 8, 15, and 22, in 28-day cycles. For patients with large pleural effusions, the starting dose of methotrexate was 15 [mg/m.sup.2], and was escalated up to 30 [mg/m.sup.2] providing no mucositis or cytopenias occurred. One patient with preexisting hearing loss received carboplatin in substitution for cisplatin at a dose of 235 [mg/m.sup.2]. Patients who were not eligible for platinum therapy received methotrexate and vinblastine alone on a weekly basis at the same doses. Doses were modified for hematologic, allergic, and neurologic toxic reactions.
Table 1--Patient Characteristics
In regards to known unfavorable prognostic factors in mesothelioma,(6),(8),(15),(16) 7 patients had thrombocytosis, 11 had 6 months or less of symptoms before diagnosis, and 9 patients had chest pain; 1 additional patient, who had peritoneal mesothelioma, had abdominal pain. Weight loss was documented in only nine patients, with a median weight loss of 4.5 kg.
Median follow-up for all patients was 12 months (range, 4.6 to 44 months). The ten patients who were treated with cisplatin, methotrexate, and vinblastine received a median of 5 monthly cycles of chemotherapy (range, 3 to 20+ months). The six patients who received only methotrexate and vinblastine received a median of 5 months (range, 3 to 12 months) of treatment, and the one patient receiving carboplatin, methotrexate, and vinblastine continues to receive therapy after receiving 8 months of treatment.
Response
All patients were evaluable for response. Four patients had bidimensionally measurable disease; of these, two had a partial remission. Of the 13 patients with evaluable disease, 2 had a complete remission and 5 had regressions. Overall response rate is 9 of 17 patients, or 53% (95% confidence interval [CI], 28 to 77%). Eight of the nine responders received three-drug therapy. The median time to progression (Fig 1) is 8 months (range, 4 to 20 months). Seven patients had stable disease, for a median duration of 5 months (range, 4 to 15 months). The median survival time of all patients is 14 months (Fig 2). Projected 2-year survival is 35% (95% CI, 12 to 60%).
Toxicity
Toxicity of the this regimen was as expected from these chemotherapy agents. There were no treatment-related deaths. One patient had vomiting requiring hospitalization (grade 4 toxicity), and three other patients had six to ten episodes of vomiting in a 24-h period (grade 3 toxicity). Myelosuppression was mild to moderate: three patients developed a neutrophil nadir of between 500 and [900/mm.sup.3], and one patient had a platelet count nadir of [49,000/mm.sup.3]. The myelosuppression lasted 2 weeks and resolved after holding the methotrexate and vinblastine for 1 week, then reducing the doses upon hematologic recovery. Other toxic reactions included one episode of methotrexate-induced pneumonitis and one of methotrexate-induced hepatitis, both of which were reversed by discontinuation of this drug therapy. Six patients developed moderate paresthesias and three developed tinnitus, necessitating discontinuation of cisplatin therapy in two patients and of vinblastine therapy in one.
DISCUSSION
This particular regimen was chosen because of reports of the efficacy of weekly methotrexate and vinblastine in desmoid tumors and retroperitoneal fibromatosis. Although desmoid tumors are histologically distinct from mesothelioma and technically benign, they share a similar pattern of locally aggressive, infiltrating spread. Methotrexate and vinblastine have a reported response rate in desmoid tumors of 72%.(9),(10) We combined these drugs with cisplatin, an agent with modest activity(11),(12),(13) in patients who we believed could tolerate the drug.
Although the number of patients in this analysis is small, we are encouraged by the results. The 53% response rate and projected 2-year survival of 35% for these patients with unresectable mesothelioma are better that those typically reported in phase 2 trials of chemotherapy, although we acknowledge that these results could be due to patient selection factors. The 18 to 77% CI for response overlaps with the response rates seen with single-agent cisplatin (13 to 36%). The small number of patients precludes determining if our response rate could be due to the platinum compound alone.
Many prognostic factors have been identified by multivariate analyses that are associated with a worse outcome for patients with malignant mesothelioma. These include the following: chest pain, age younger than 50 years, less than 6 months of chest pain (for pleural mesothelioma), performance status of 2 (unable to work, but ambulatory [greater than]50% of the day) or performance status greater than 2 (limited ability for self-care, confined to bed or chair [greater than]50% of the day), thrombocytosis of 400,000 or more, advanced stage, and asbestos exposure.(6),(8),(15),(16) We believe that it is unlikely that our results are explained by a preponderance of good prognostic factors, since most of our patients were older than 50 years, had chest pain as a predominant symptom, and had a less than 6-month duration of symptoms. Most (ten) of our patients had epithelial mesothelioma, which can have a relatively indolent course. Responses to treatment, however, were seen in patients having either epithelial (six of ten) or mixed (three of six) histologic type; the one patient with sarcomatoid mesothelioma had stable disease. Toxic reactions were moderate overall, as expected from these drugs.
Regression by comparison of serial CT scans was used as a measure of response in this analysis, as has been done in many phase 2 reports of mesothelioma response to treatment. Because mesothelioma typically infiltrates the pleura or peritoneum without producing a bidimensionally measurable mass, assessment can be difficult. We considered our patients to have had a regression if two different investigators agreed that there was a definite decrease in the tumor's size and no new lesions appeared for 8 weeks. In non-small cell lung cancer, regression carries the same prognostic implications as partial remission.(17)
Although the small number of patients and the retrospective nature of this study make it difficult to draw valid comparisons of subsets, we observed a differential response rate for patients receiving three-drug therapy compared with those receiving methotrexate and vinblastine alone. Of the 11 patients who received platinum, methotrexate, and vinblastine, 1 had a complete remission, 2 had partial remissions, and 5 had regressions (8 of 11 patients). Of the six receiving methotrexate and vinblastine alone, there was only one responder (a patient who had a complete remission). This differential response rate for the three-drug combination may be due to a synergistic effect among the three drugs or perhaps due to the platinum compound alone. Further investigation of the three-drug regimen is warranted in confirmatory trials.
REFERENCES
(1) Vogelzang NJ. Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 1992; 19:64-71
(2) Sridhar KS, Doria R, Raub WA, et al. New strategies are needed in diffuse malignant mesothelioma. Cancer 1992; 70:2960-79
(3) Branscheid D, Krysa S, Bauer E, et al. Diagnostic and therapeutic strategy in malignant pleural mesothelioma. Eur J Cardiothorac Surg 1991; 5:466-72
(4) Rusch VW. Diagnosis and treatment of pleural mesothelioma. Semin Surg Oncol 1990; 6:279-85
(5) Achatzy R, Beba W, Ritschler R, et al. The diagnosis, therapy and prognosis of diffuse mesothelioma. Eur J Cardiothorac Surg 1989; 3:445-47
(6) Ruffie P, Feld R, Minkin S, et al. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 1989; 7:1157-68
(7) Krarup-Hansen A, Hansen HH. Chemotherapy in malignant mesothelioma: a review. Cancer Chemother Pharmacol 1991; 28:319-30
(8) Alberts AS, Falkson G, Goedhals L, et al. Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers. J Clin Oncol 1988; 6:527-35
(9) Weiss A, Lackman R. Chemotherapy of desmoid tumors and fibromatosis [abstract]. Proc Am Soc Clin Oncol 1994; 13:401
(10) Weiss AJ, Lackman RD. Low-dose chemotherapy of desmoid tumors. Cancer 1989; 64:1192-94
(11) Zidar BL, Green S, Pierce HI, et al. A phase II evaluation of cisplatin in unresectable diffuse malignant mesothelioma: a South-west Oncology Group study. Invest New Drugs 1988; 6:223-26
(12) Planting AS, Schellens JH, Goey SH, et al. Weekly high dose cisplatin in malignant pleural mesothelioma. Ann Oncol 1994; 5:373-74
(13) Mintzer DM, Kelsen D, Frimmer D, et al. Phase II trial of high dose cisplatin in patients with malignant mesothelioma. Cancer Treat Rep 1985; 69:711-12
(14) Kalbfleish JD, Prentice RL. The statistical analysis of failure time data. New York: John Wiley & Sons, 1980; 10-6
(15) Antman K, Shemin R, Ryan L, et al. Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985. J Clin Oncol 1988; 6:147-53
(16) Chahinian AP, Pajak TF, Holland JF, et al. Diffuse malignant mesothelioma: prospective evaluation of 69 patients. Ann Intern Med 1982; 96:746-55
(17) Jett JR, Su JQ, Krook JE, et al. Measurable or assessable disease in lung cancer trials: does it matter? J Clin Oncol 1994; 12:2677-81
COPYRIGHT 1996 American College of Chest Physicians
COPYRIGHT 2004 Gale Group
by Karen J. Hunt, Gary Longton, Margaret A. Williams, Robert B. Livingston
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