Memorial Sloan Kettering Cancer Center in New York City has started a new clinical trial studying pleural mesothelioma. Researchers are studying the effectiveness of an immunotherapy and chemotherapy combination prior to aggressive surgery.

About Pleural Mesothelioma

Pleural mesothelioma is cancer that develops in the cells that form the outer lining of the lungs and inner lining of the chest cavities. It is the most common type of asbestos-related cancer. Specialists use the latest therapies to treat it, and clinical trials offer access to new treatments such as immunotherapy.

• Most common type
• Forms on soft tissue covering the lungs
• Best treated with a multimodal approach (combination of treatments)
• Symptoms: Shortness of breath, chest pain, dry cough

Pleural Mesothelioma Causes

After a person inhales asbestos dust, the human body struggles to remove the mineral’s needle-like fibers from the lungs. Over a long period of time, trapped fibers migrate to the pleural lining and cause irritation and chronic inflammation.
The trapped fibers cause pleural mesothelioma by triggering genetic changes that turn cells cancerous. These cancerous cells grow fast and uncontrollably, threatening the organs around them.
Two layers make up the pleura lining. The outer layer, called the parietal pleural membrane, lines the entire inside of the chest cavity. The inner layer, or visceral pleural membrane, covers the lungs. A pleural mass can develop on either layer and quickly spread to the other layer. As tumors develop on the pleural surface, they grow to form a sheath-like mass around the lung.

Pleural Mesothelioma Symptoms

Many don’t notice the symptoms of pleural mesothelioma right away. People brush them off, especially the elderly. The early symptoms often mirror signs of less serious respiratory issues, such as pneumonia, bronchitis, and emphysema. These symptoms are a common occurrence for seniors.  Then, the symptoms grow more serious. These can be chest pain, slight fatigue or shortness of breath during physical activity.
Once the cancer progresses to a late stage, however, the symptoms become much more specific and acute.

Pleural Mesothelioma Diagnosis

Doctors sometimes mistake pleural mesothelioma for common diseases with similar symptoms, such as the flu or pneumonia. Rare cancer requires extensive testing to diagnose. The diagnostic process begins when a doctor, often a primary care physician, evaluates initial symptoms. Chest pain and breathing impairment warrant a chest X-ray, typically the first test to show fluid or tumors around the lungs.
Referral to a pulmonologist, oncologist or general hospital is common after an abnormal X-ray. Further imaging, blood tests, and tissue biopsies are used to confirm a pleural mesothelioma diagnosis.
It is challenging for doctors to tell the difference between pleural mesothelioma and lung cancer in some cases. While doctors may suspect mesothelioma based on a patient’s scans, symptoms, and history of asbestos exposure, these signs are not enough to confirm a diagnosis.
The most reliable tool to diagnose the disease is a thoracoscopy. This minimally invasive procedure allows doctors to view the patient’s chest through a small camera and collect a tissue sample, also known as a biopsy. A pathologist examines the biopsy under a microscope to confirm the diagnosis and distinguish cancer’s cell type.

New Pleural Mesothelioma Trial

Researchers will determine if Opdivo with Alimta and either cisplatin or caroplatin can extend a patient’s survival time. Those in the study will undergo two cycles of Opdivo and chemotherapy prior to any surgery. Then, researchers will measure the progress within 30 days of treatment. This trial is only for patients who qualify for surgery. However, the FDA has not approved Opdivo outside of clinical trials.
There are other mesothelioma trials currently underway at Memorial Sloan Kettering. These include targeted cancer vaccines combined with Opdivo. Another shows immunotherapy of a patient’s T cells.

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