In a dramatic departure from mesothelioma treatment in the United States, specialists in the United Kingdom have decided they will no longer recommend aggressive surgery as part of patient care unless the procedures are being studied as part of a specific study. This decision, which is outlined in the Mesothelioma Management Guidelines for 2018 just published by the British Thoracic Society, follows an analysis of the potential harm and poor outcomes experienced by patients undergoing extra pleural pneumonectomy (EPP), extended pleurectomy and decortication (P/D), and partial pleurectomy (PP) which are frequently offered in the United States.
The new mesothelioma treatment guidelines were based in large part on the results of a study that recently appeared in the Clinical Respiratory Journal. That analysis made its conclusions based on hundreds of previously conducted clinical trials, and arrived at the difficult conclusion that aggressive surgery was not providing enough benefit to offset its adverse effects. The lead author of that study was Dr. Anna Libby of the University of Bristol Medical School and North Bristol NHS Trust. With the article, she writes, “Current evidence does not support surgical intervention. However, investigations are ongoing, including the MARS2 trial that is looking at the less-aggressive (E)P/D surgery.” The new guidelines explicitly recommend against offering EPP at all pleural mesothelioma patients, against offering EPD unless as part of a clinical trial, and that radiation therapy should only be used with the goal of offering pain relief and quality of life improvement rather than for a curative approach.
Instead of taking an aggressive surgical approach, mesothelioma specialists in the United Kingdom are opting to focus their attention on innovative new approaches, including immunotherapy drugs like bevacizumab, which has been shown to stop the growth of cancer cells when used in tandem with chemotherapeutic drugs. There is also great hope for genetic therapy approaches and other personalized medicine protocols.
Though there are philosophical differences between the United States and the United Kingdom when it comes to mesothelioma treatment, all involved seek a cure and the best possible outcomes for patients diagnosed with this rare and fatal form of cancer. If you need information on the resources available to you, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.
