Neoadjuvant chemotherapy is typically used to shrink tumors before surgery to make it easier to remove them. It has been thought that the combination of drugs and surgery can help patients survive longer, but a study at Duke has found that it does not increase survival in pleural mesothelioma patients.
The study is showing that the combination therapy cisplatin and pemetrexed is better to give after someone receives surgery rather than before. Even if the drugs shrink the tumors, it does not help patients survive for a longer period of time, so it could do more harm than good.
Neoadjuvant therapy is used because it was always thought that it can make surgery more effective and even make patients eligible who were previously ineligible. The study compared patients who received chemotherapy before surgery to patients who never received chemotherapy before surgery. Patients who underwent adjuvant chemotherapy had a higher chance of post-surgery death versus those who just received surgery. Those undergoing adjuvant chemotherapy also lived for a shorter period of time. People who just received surgery had a median 19-month survival compared to 16 months for those undergoing neoadjuvant chemotherapy. The data is still not good enough to suggest that no patients should undergo adjuvant chemotherapy, so it could still potentially be good for certain patients.
Neoadjuvant therapy is highly debated in the mesothelioma treatment community. There are no guidelines saying what is best for mesothelioma patients. Procedures using adjuvant chemotherapy resulted from other studies showing there could be increased survival rates for patients who could not receive surgery due to the cancer spread.
It has been thought that neoadjuvant chemotherapy could allow remission in patients, shrinkage of tumors, and the ability for the cancer to be completely removed. The Duke study contradicted this and showed that there is no survival benefit. Only 20 percent of the participants showed a response to the treatment.
Other problems can arise from adjuvant chemotherapy including patients not responding to the treatment. They would still need to finish the treatment, delaying the beneficial surgery and allowing the cancer to spread. Those receiving surgery could also have negative side effects that lead to a harder recovery. With so many problems, adjuvant chemotherapy is not a straightforward choice for those suffering from mesothelioma. Consult your doctor to find the best available treatment for you