39-Sugarbaker - How has the treatment of mesothelioma changed over the last 25 years
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Exclusive Content | Dr. David Sugarbaker: How have treatments changed over the last 25 years?
39-Sugarbaker - How has the treatment of mesothelioma changed over the last 25 years

Exclusive Content

Dr. David Sugarbaker: How have treatments changed over the last 25 years?

Written by Michelle Whitmer | Scientifically Reviewed By Yvonne Waterman | Edited By Walter Pacheco | Last Update: November 13, 2024

How Do People Get Mesothelioma?

The primary cause of mesothelioma is asbestos exposure. Most cases trace back to occupational exposure in the workplace.

Mesothelioma carries a long latency period. It can take anywhere from 15 to 70 years for the cancer to develop after a person’s first exposure to asbestos.

Secondary asbestos exposure also causes mesothelioma. Workers can unknowingly take asbestos fibers home on their clothes or equipment. This, in turn, exposes their families to danger. Mainly, it’s the spouses and children of these workers who are affected.

Quick Fact
Between 8% and 13% of workers with heavy exposure to asbestos eventually develop mesothelioma.

When Was Mesothelioma First Discovered?

Tumors in the mesothelium were first identified in the mid-1700s. The term “mesothelioma” was first used in the early 1900s. It forms in the mesothelium, a protective layer that surrounds internal organs.

  • 1960
    J. Christopher Wagner published a study of 33 mesothelioma cases linked to an asbestos mine in South Africa. It confirmed the causal relationship beyond a reasonable doubt.
  • 1943
    H.W. Wedler was a German researcher. He published a study of asbestos workers. It showed a connection between asbestosis and pleural mesothelioma.
  • 1935
    Steven R. Gloyne was a British pathologist. He was the first to suggest that working with asbestos causes mesothelioma.
  • 1909
    J.G. Adami coined the term “mesothelioma” to classify this rare cancer.
  • Early 1900s
    The medical community began to accept that cancers could originate in the pleura.
  • 1843
    Karl Freiherr von Rokitansky was a professor at Vienna University. He suggested that pleural cancer is always linked to primary cancer in other parts of the body. This idea dominated medical thinking for years. Then, in 1854, he identified primary tumors in the peritoneum. This was one of the earliest cases of peritoneal mesothelioma.
  • 1819
    René-Théophile-Hyacinthe Laennec, a French doctor, invented the stethoscope. He also proposed that cancer could develop in the pleura.
  • 1767
    Joseph Lieutaud is the founder of pathologic anatomy in France. He first noted a tumor in the pleural mesothelium, which lines the lungs. He also documented the first cases of pleural mesothelioma.

Research established a link between mesothelioma and asbestos exposure. In the 1920s, workers began to file lawsuits. By the end of the 1970s, mesothelioma lawsuits had become widespread.

Historical Studies of Mesothelioma and Asbestos Exposure

For decades, research has shown mesothelioma is unique and linked to asbestos. Studies since the 1940s have tied asbestos to this rare cancer.

Research on Mesothelioma and Asbestos

  • Environmental Studies: Research on environmental asbestos exposure and mesothelioma started in 2000. A study showed living within 2000 meters of asbestos sites raised mesothelioma risk. Then, in 2017, a review found work exposure was still the top cause of this rare cancer.
  • British Study: A study found mesothelioma in people living near a London asbestos factory. It was led by British doctor Molly Newhouse. By 1968, the British Medical Journal linked most cases to asbestos. However, a debate continued over which types of asbestos were the most cancerous.
  • American Study: In 1964, a conference on asbestos’s effects was held. Dr. Irving J. Selikoff spoke about more than 1,000 workers from the Union Asbestos & Rubber Company in Patterson, New Jersey. He found their death rate was 25% higher than normal. They died from asbestosis, lung cancer, stomach cancer, and colorectal cancer.
  • South African Study: In 1960, J.C. Wagner and Dr. Chris Sleggs studied asbestos exposure. They linked it to 33 mesothelioma cases in South Africa. The area’s crocidolite asbestos mining had caused the contamination. Eight cases were related to work. The rest were from living near the mines.
  • Groundbreaking German Study: In 1943, H.W. Wedler linked asbestosis to pleural cancer in German asbestos workers. About 20% of these workers got cancer, with lung cancer being more common than mesothelioma. Wedler’s study was well received in Germany. But the political climate at the time caused the rest of the world to ignore research coming from Nazi Germany.

Early research linked asbestos to mesothelioma. Studies showed that exposure, whether at work or in the environment, increases the risk of mesothelioma and other cancers.

History of Mesothelioma Treatment

Surgeries were the first treatments for mesothelioma. Then, in the 1950s, radiation therapy emerged. Chemotherapy followed in the 1970s.

After years of research, no cure for the four mesothelioma types is found. Yet treatments have improved, allowing for longer, better lives. Surgery can even extend life beyond the usual one-year estimate for some.

Innovative clinical trials are seeking a cure for mesothelioma. At the same time, researchers aim to improve its diagnosis. This progress could lead to earlier detection and better prognosis.

Advancements in Surgery

Surgery for mesothelioma began in the 1940s using pneumonectomy and pleurectomy. Pneumonectomy is also used to treat lung cancer.

The pleurectomy and decortication procedure is mesothelioma surgery. It was created in the 1960s and is still used today. Initially, it helped patients with trapped lungs due to tuberculous empyema. Now, it also aids those with mesothelioma.

27% and 50%

Percentage of pleural patients and peritoneal patients, respectively, who qualify for surgery.

In the 1970s, doctors tried a surgery called an extrapleural pneumonectomy. The mortality rate for this surgery back then was as high as 31%. Today, it’s around 4% in leading cancer centers.

Heated intraperitoneal chemotherapy, or HIPEC, was developed in the 1990s. The late Dr. Paul Sugarbaker was one of the first to use it for peritoneal mesothelioma patients. Now, HIPEC surgery allows half of these patients to survive beyond five years.

Advancements in Chemotherapy

From the 1970s to the 1990s, various chemotherapy drugs treated mesothelioma. Their response rates, between 20% and 40%, led doctors to seek better options than 5 years.

The U.S. Food and Drug Administration has included cisplatin and pemetrexed in the standard treatment for mesothelioma. This combination is now the most common therapy for the disease.

In the 1990s, heated chemotherapy was tested as a treatment. Usually, it followed surgery, but some patients got it without surgery.

Quick Fact
In 2003, the phase III trial of cisplatin and pemetrexed (Alimta) reported the best chemotherapy response rate to date of 41.3%.

Advancements in Radiation Therapy

In the 1950s, doctors started using radiation therapy for mesothelioma. They injected radioactive colloidal gold into the pleura. However, for decades, they thought it was too risky to target the lung lining. The concern was potential damage to vital organs like the heart.

A 2001 phase II clinical trial changed that perspective. It reported a low 13% local recurrence with radiation therapy. Application after extrapleural pneumonectomy surgery was key. Advanced techniques used today reduce radiation exposure to vital organs.

A newer type of radiation called proton therapy uses a beam of protons instead of photons. It better targets mesothelioma tumors. Proton therapy is only available at specific cancer centers in the U.S.

“The advantages of radiation therapy for mesothelioma are getting better and better every day. New advanced types of radiation therapy are coming out, including proton therapy, which reduces the risk of healthy tissue damage by using particles that don’t escape the cancer and only stay within the cancer abnormal cells, not affecting healthy tissue.”

Sean Marchese, registered nurse
Sean Marchese

FDA Approves New Therapies for Mesothelioma

In 2019 and 2020, the U.S. FDA approved two new mesothelioma therapies. One is the first immunotherapy combination of drugs like Opdivo, Keytruda and Yervoy for this cancer. The other, Tumor Treating Fields, uses electrical fields to curb growth.

Recently Approved Mesothelioma Treatments

  • Immunotherapy: In 2024, the FDA approved using Keytruda (pembrolizumab) with chemotherapy for mesothelioma. Earlier in 2020, the FDA approved Opdivo (nivolumab) and Yervoy (ipilimumab) together for mesothelioma. This treatment offers 18 months of survival, better than the 14 months with chemotherapy. Moreover, two-year survival rates rise from 27% in chemotherapy to 41% in immunotherapy.
  • Tumor Treating Fields: In 2019, the FDA approved Tumor Treating Fields (TTFields) for mesothelioma with chemotherapy. TTFields uses electrical fields to fight tumors. This combination therapy extends life by about six months on average.

It can take decades for a therapy to receive approval because the FDA must ensure it is safe and effective for the public.

Emerging Treatments

Emerging treatments for mesothelioma are under development in clinical trials throughout the world. Therapies under investigation for mesothelioma treatment include new immunotherapy drugs, vaccine therapy, gene therapy, epigenetic therapy, virotherapy and anti-angiogenic drugs. 

Photodynamic therapy, which uses light and drugs, is being tested for mesothelioma. It kills cancer cells. Cryotherapy, on the other hand, uses extreme cold to treat cancer. A study in 2020 showed it could relieve chest pain. Many of these treatments are available in U.S. clinical trials.

Future of Mesothelioma Research

Certain U.S. cancer centers focus on mesothelioma treatments and trials. For example, Boston’s Brigham and Women’s Hospital is noted for its surgical skill and leadership in trials. Similarly, the Pacific Mesothelioma Center in Los Angeles has been investigating immunotherapy and gene therapy since 2002.

The mesothelioma program at the University of Chicago Comprehensive Cancer Center helped develop the only FDA-approved chemotherapy regimen for mesothelioma. The Mesothelioma International Treatment Program at AdventHealth Cancer Institute in Orlando, Florida, is known for robotic surgery and clinical research.

Anne-Wolf-15-What is the future of cancer treatment including mesothelioma

Expert Take

Dr. Andrea Wolf: Learn about the future of mesothelioma treatment

Since 1991, the mesothelioma community has met every two years for the International Mesothelioma Interest Group Meeting. Researchers and experts worldwide gather to share treatment progress and discuss future research for a cure.

In 2009, Sydney, Australia, opened the first facility solely for mesothelioma research. The Asbestos Diseases Research Institute focuses on treating mesothelioma. It also looks into how mesothelioma is diagnosed and its psychological effects on patients and families.

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