National Comprehensive Cancer Network Announces New Mesothelioma Guidelines

At the Fifteenth Annual National Comprehensive Cancer Network Conference in Hollywood, Florida, Dr. Lee Krug announced that the Network’s panel on Guidelines for Malignant Pleural Mesothelioma (MPM) released new recommendations for treatment methods of the deadly lung disease. Mesothelioma, a form of cancer that affects the fluid lining of the lungs, is often linked to asbestos exposure and can often go for decades without symptoms.

One of the reasons that malignant mesothelioma is so difficult to diagnose, according to Dr. Krug, is that the disease’s symptoms, such as chest pain, breathing problems and sudden weight loss, often resemble those of other lung disorders. Once doctors are able to diagnose the disease, patients typically live less than two years. However, Dr. Krug, a specialist at New York’s Sloan-Kettering Cancer Center, noted that mesothelioma patients have higher levels of certain cell proteins, which doctors can potentially use to make an earlier diagnosis.

Among the panel’s recommendations was the use of surgery as a first-line treatment. The typical surgical technique in these cases would be a pleurectomy, which involves removing all or part of the pleura, the fluid membrane that surrounds and protects the lungs. Another type of surgery would be an extrapleural pneumonectomy, a radical surgery that involves removing portions of the pleura, lung, diaphragm and pericardium, a protective membrane that covers the heart.

Since many forms of cancer carry their malignant genes throughout the body via the lymph system, Dr. Krug and the panel also recommended that patients undergo a surgical procedure called “mediastinal lymph node dissection”. This procedure involves opening up the main lymph node that rests between the lungs. The status of this lymph node can inform doctors about the stage and aggressiveness of the malignancy.

Dr. Krug also noted that surgery, while a primary component of the treatment process, should not stand alone as the sole solution. He also stated that both chemotherapy and radiation treatments as methods that would continue to attack any remaining traces of the tumors. He said that, although earlier studies have shown that MPM tumors had shown resistance to some chemotherapy treatments, patients have responded well to a regimen that combines pemetrexed (brand name: Alimta) and cisplatin (brand name: Platinol) or carboplatin (brand name: Paraplatin) as a first-line treatment method.

The panel also set guidelines for the use of radiation therapy. Dr. Krug explained that radiation can be used to “improve local control” of the affected area after the patient recovers from surgery. According to the panel’s recommendations, radiation can also be used to relieve some of the pain tied to the disease.

In other news at the conference, the panel also released new recommendations on how to classify lung cancer tumors. The new staging scheme classifies non-small-cell lung cancer tumors by size:

Dr. David Ettinger of Johns Hopkins University in Baltimore, Maryland, announced the changes to the classification system. He stated that the previous staging system only covered tumors as large as 3 cm across, where the new system covers malignant growths up to 7 cm.

Sources: BusinessWire, DocGuide.com