The Food and Drug Administration (FDA) recently approved Alimta (pemetrexed disodium) for use in combination with cisplatin for the treatment of patients with malignant pleural mesothelioma. It is the first drug approved for this condition.

Mesothelioma treatment can involve surgery, chemotherapy, radiation, or a combination of the three. Malignant mesothelioma is, however, difficult to treat as it can spread quickly to nearby organs. Mesothelioma treatment is most successful if the disease is diagnosed at an early stage. A staging system is used to determine just how advanced the case is.

In stage 1, the disease has only spread as far as the pleura. At this stage, tests are done to make sure the cancer has not spread, and to check if the lungs and heart are functioning well. If the patient is young and healthy, aggressive surgery can be attempted. This is high-risk surgery and involves the removal of the pleura, the lung, the diaphragm and the pericardium. Radiation or chemotherapy is commonly done post-surgery to eliminate any remaining tumor cells. In heated intraoperative intraperitoneal chemotherapy, surgery is followed by the direct administration of a chemotherapy agent, heated to between 40 and 48C, in the abdomen. This can increase the penetration of the drugs into tissues. Moreover, the damage produced by heat is greater to cancerous cells than to normal cells.

In stage two of mesothelioma, the cancer has reached the chest wall. By stage three it has affected the diaphragm. In stage four there are signs of metastases spreading through the blood stream. If surgery is undertaken during these stages, it is generally only for relief of symptoms. A needle may be inserted into the chest to drain the fluid, relieving breathlessness and pain. Talc may be injected into the pleural space to stop fluid from accumulating. Or the pleura may be surgically removed to alleviate the pain. Radiation therapy and chemotherapy can also be used to relieve the symptoms.