Ann Arbor Hematology Oncology Associates, P.C.
5301 Huron River Drive, Suite C-139
Ypsilanti, Michigan 48197
Phone: 734.712.1000
Fax: 734.712.1012
Arizona Cancer Center
1515 North Campbell Avenue
Tucson, Arizona 85724
Phone: 520.694.2873
Fax: 520.626.7924
Banner Good Samaritan Medical Center
1111 E. McDowell Road
Phoenix, Arizona 85006
Phone: 602.239.2000
Fax: 602.239.3749
Baptist Centers for Cancer Care
350 N. Humphreys Blvd.
Memphis, Tennessee 38120
Phone: 888.391.6558
Email Address: bccc@bmhcc.org
Barbara Ann Karmanos Cancer Institute
The National Center for Vermiculite and Asbestos-Related Cancers
4100 John R
Detroit, Michigan 48201
Phone: 800.527.6266
Barnes-Jewish Hospital
4921 Parkview Place
St. Louis, Missouri 63110
Phone: 866.867.3627
Cancer Center of Kansas, Community Clinical Oncology Program of Wichita
818 N. Emporia, #403
Wichita, Kansas 67214
Phone: 316.262.4467
The University of Texas Health Science Center
7979 Wurzbach Road
San Antonio, Texas 78229
Phone: 800.3401.2872
Email Address: onctrial@idd.org
Cancer Treatment Centers of America
10109 East 79th Street
Tulsa, Oklahoma 74133
Phone: 918.286.5000
Cedars-Sinai Medical Center
8700 Beverly Boulevard
Los Angeles, California 90048
Phone: 800.773.2742
City of Hope Comprehensive Cancer Center
1500 East Duarte Road
Duarte, California 91010
Phone: 626.359.8111
Comprehensive Cancer Center of Wake Forest University
Thoracic Oncology Clinic
Medical Center Boulevard
Winston-Salem, North Carolina 27157
Phone: 800.446.2255
Email Address: rnhoc@wfubmc.edu
Creighton University Medical Center Cancer Center
601 North 30th Street
Suite 2803
Omaha, Nebraska 68131
Phone: 402.280.4100
Fax: 402.280.3448
Email Address: CancerCenter@creighton.edu
Dana-Farber Cancer Center Institute
44 Binney Street
Boston, Massachusetts 02115
Phone: 888.876.8008
Fax: 617.632.4413
Email Address: Dana-FarberContactUs@dfci.harvard.edu
David Geffen School of Medicine
Los Angeles, California 90095
Phone: 310.825.6373
David Geffen School of Medicine at UCLA, Division of Pulmonary and Critical Care Medicine
200 UCLA Medical Plaza, Suite 365B
Los Angeles, California 90095
Phone: 310.825.5988
Fax: 310.206.8622
Fox Chase Cancer Center
333 Cottman Avenue
Philadelphia, Pennsylvania 19111
Phone: 888.369.5427
Geisinger Health Systems Cancer Institute
100 N. Academy Avenue
Danville, Pennsylvania 17822
Phone: 800.275.6401
Hamon Center for Therapeutic Oncology Research
6000 Harry Hines Blvd. NB8.206
Dallas, Texas 75390
Phone: 214.648.4900
Fax: 214.648.4940
Email Address: news@utsouthwestern.edu
Harold C. Simmons Comprehensive Cancer Care Center
5323 Harry Hines Boulevard
Dallas, Texas 75390
Phone: 214.648.3111
Fax: 214.648.9119
Email Address: news@utsouthwestern.edu
Hematology and Oncology Associates of Central New York
5008 Brittonfield Parkway
East Syracuse, New York 13057
Phone: 315.472.7504
Fax: 315.472.5935
Herbert Irving Comprehensive Cancer Center
1130 St. Nicholas Avenue
New York, New York 10032
Phone: 212.851.5273
Fax: 212.851.5236
Humility of Mary Health Partners
667 Eastland Avenue SE
Warren, Ohio 44484
Phone: 330.841.4177
Ketchikan General Hospital
3100 Tongass Avenue
Ketchikan, Alaska 99901
Phone: 907.934.9999
Lone Star Oncology
11044 Research Blvd.
Austin, Texas 78759
Phone: (512) 343-2103
Mayo Clinic
13400 East Shea Blvd.
Scottsdale, Arizona 85259
Phone: 480.301.8000
Fax: 480.301.7006
Mayo Clinic Cancer Center
200 First Street SW
Rochester, Minnesota 55905
Phone: (507) 284-2511
MedCenter One Health Systems Cancer Care Center
300 North 7th Street
Bismarck, North Dakota 58501
Phone: 701.323.5741
Email Address: webmaster@mohs.org
Medical University of South Carolina
86 Jonathan Lucas Street
Charleston, South Carolina 29425
Phone: 843.792.0700
Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, New York 10065
Phone: 888-675-7722
Email Address: publicaffairs@mskcc.org
Memphis Veterans Affairs Medical Center
1030 Jefferson Avenue
Memphis, Tennessee 38104
Phone: 800.636.8262
Fax: 901.577.7251.
Mount Sinai Medical Center
1 Gustave L Levy Place
New York, New York 10029
Phone: (212) 241-5555
Mt. Zion Medical Center, Urologic Oncology, Comprehensive Cancer Center
1600 Divisadero Street
3rd Floor/4th Floor
San Francisco, California 94143
Phone: 415.353.7171
Fax: 415.353.9530
Email Address: referral.center@ucsfmedctr.org
National Cancer Institute
6116 Executive Boulevard
Bethesda, Maryland 20892
Phone: 800.422.6237
National Jewish Hospital
1400 Jackson Street
Denver, Colorado 80206
Phone: 303.388.4461
New York-Presbyterian Hospital, Columbia University Medical Center
16 East 60th Street
New York, New York 10021
Phone: 800.227.2762
Fax: 201.346.7010
Email Address: Info@columbiasurgery.org
New York University Medical Center - NYU Langone Medical Center
550 First Avenue
New York, New York 10016
Phone: (212) 263-7300
Norris Cotton Cancer Center
One Medical Center Drive
Lebanon, New Hampshire 03756
Phone: 603.653.9000
Email Address: 603.653.9003
Ochsner Cancer Institute at Ochsner Clinic Foundation
1514 Jefferson Highway
New Orleans, Louisiana 70121
Phone: 888.624.7637
Email Address: cancercenter@ochsner.org
Roswell Park Cancer Institute
Elm & Carlton Streets
Buffalo, New York 14263
Phone: (800) 767-9355
E-mail: askrpci@roswellpark.org
Saint Louis University Cancer Center
3655 Vista Avenue
West Pavilion
St. Louis, Missouri 63110
Phone: 866.977.4440
Email Address: cancercenter@slu.edu
Samaritan Regional Cancer Center
501 NW Elks Drive
Corvallis, Oregon 97330
Phone: 541.768.5220
Scott & White Healthcare, The Cancer Institute
2401 S. 31st Street
Temple, Texas 76508
Phone: 800.792.3710
Email Address: appointments@swmail.sw.org
Somerset Medical Center
110 Rehill Avenue
Somerville, New Jersey 08876
Phone: 908.685.2200
Southern Nevada Cancer Research Foundation (CCOP)
601 S. Rancho Dr., C-26
Las Vegas, Nevada 89106
Phone: 702.384.0013
Fax: 702.384.9776
Email Address: s.Yates@sncrf.org
S.R. Burzynski Clinic
9432 Old Katy Road
Suite 200
Houston, Texas 77055
Phone: 713.335.5697
Fax: 713.935.0649
Email Address: info@burzynskiclinic.com
St. Joseph Medical Center
1717 South J Street
Tacoma, Washington 98405
Phone: 253.426.6810
St. Joseph Mercy Oakland
44405 Woodward Avenue
Pontiac, Michigan 48341
Phone: 248.858.3000
Swedish Cancer Institute at Swedish Medical Center
747 Broadway
Seattle, Washington 98122
Phone: 206.386.6000
The Center for Cancer Care and Research
12855 North Forty Drive
Saint Louis, Missouri 63141
Phone: 314.628.1212
The National Cancer Center, Tsukiji Campus
5-1-1 Tsukiji
Chou-ku, Tokyo , Japan
Phone: 03.3542.2511
The University of Texas M.D. Anderson Cancer Center
Thoracic Center
1515 Holcombe Boulevard
Houston, Texas 77030
Phone: 800.392.1611
Toledo Community Hospital Oncology Program
3232 Central Park West, Suite C
Toledo, Ohio 43617
Phone: 419.843.6147
Fax: 419.843.6137
Tower Hematology Oncology Medical Group
9090 Wilshire Boulevard
Suite 200
Beverly Hills, California 90211
Phone: 310.888.8680
UCLA Medical Center Department of Surgery
10833 Le Conte Ave.
Box 957313
Los Angeles, California 90095
Phone: 310.206.6691
UCSF Medical Center, Helen Diller Family Comprehensive Cancer Center
Box 0128, UCSF
San Francisco, California
Phone: 415.885.3882
Fax: 415.353.9525
Email Address: referral.center@ucsfmedctr.org
University of Alabama at Birmingham, Comprehensive Cancer Center
Mesothelioma Treatment Section
1824 6th Avenue South
Birmingham, Alabama 35294
Phone: 205.934.9999
Fax: 205.975.2432
University of Colorado at Denver Health Sciences Center
The Anschultz Medical Campus
13001 E. 17th Place
Aurora, Colorado 80045
Phone: 720.848.0000720.848.0000
Fax: 303.724.1521
Email Address: mitzi.schindler@uchsc.edu
University of Colorado Cancer Center, Anschutz Cancer Pavilion
1665 N. Ursula Street, PO Box 6510
Aurora, Colorado 80045
Phone: 720.848.0300
University of Colorado Cancer Center, Division of Medical Oncology
University of Colorado Health Sciences Center
12801 E. 17th Avenue
Aurora, Colorado 80010
Phone: 303.724.3888
Fax: 303.724.3889
University of Michigan Comprehensive Cancer Center
1500 East Medical Center Drive
CCGC 6-303
Ann Arbor, Michigan 48109
Phone: 734.647.8902
Fax: 734.936.8902
Email Address: Cancer-Center-Webmaster@med.umich.edu
University of Minnesota Cancer Center, Thoracic Oncology Clinical Program
Academic Health Center
754 CCRB (MMC 806)
Minneapolis, Minnesota 55401
Phone: 888.226.2376
Fax: 612.626.3069
Email Address: ccinfo@umn.edu
University of Mississippi Medical Center, Mississippi Cancer Registry
2500 North State Street
Jackson, Mississippi 39216
Phone: 888.815.2005
Fax: 601.815.5010
University of New Mexico Cancer Center
900 Camino de Salud NE
1 University of New Mexico
Albuquerque, New Mexico 87131
Phone: 800.432.6806
Fax: 505.272.1465
University of North Carolina, Lineberger Comprehensive Cancer Center
School of Medicine CB# 7295
450 West Drive
Chapel Hill, North Carolina 27599
Phone: 919.966.8128
Fax: 919.966.6735
Email Address: lccc@med.unc.edu
University of Pennsylvania Abramson Cancer Center
3400 Spruce Street
Philadelphia, Pennsylvania 19104
Phone: 800.789.7366
University of Pennsylvania Medical Center
Division of Cardiothoracic SurgeryDivision of Cardiothoracic Surgery
3400 Spruce Street
Philadelphia, Pennsylvania 19104
Phone: 215.662.4000
University of Utah Huntsman Cancer Institute
1950 Circle of Hope
Salt Lake City, Utah 84112
Phone: 800.824.2073
Email Address: patient.education@hci.utah.edu
University of Vermont, Vermont Cancer Center
E-213 Given Building
89 Beaumont Avenue
Burlington, Vermont 05405
Phone: 802.656.4414
Fax: 802.656.8788
Email Address: vcc@unm.edu
University of Washington Medical Center
1959 NE Pacific
Seattle, Washington 98104
Phone: 206-543-6420
Fax: 206-543-1600
University of Wisconsin Hospital and Clinics, Carbone Cancer Center
600 Highland Avenue
Madison, Wisconsin 53792
Phone: 800.323.8942
UPMC Cancer Center at UPMC Presbyterian
200 Lothrop Street
Pittsburgh, Pennsylvania 15213
Phone: 412.647.3600
Email Address: PCI-INFO@upmc.edu
Veterans Affairs Medical Center, Memphis
1030 Jefferson Avenue
Memphis, Tennessee 38104
Phone: 800.636.8262
Fax: 901.577.7251
Virginia Oncology Associates Cancer Treatment Center
5900 Lake Wright Drive
Norfolk, Virginia 23502
Phone: 757.213.5700
Fax: 757.213.5701
Wake Forest University School of Medicine, Department of General Surgery
Medical Center Boulevard
Winston-Salem, North Carolina 27157
Phone: 336.716.4241
Fax: 336.716.5414
Email Address: Surgeryinfo@wfubmc.edu
Western Pennsylvania Hospital
4800 Friendship Avenue
Pittsburgh, Pennsylvania 15224
Phone: 412.578.3505
Wheeling Hospital
1 Medical Park
Wheeling, West Virginia 26003
Phone: 304.243.3490
Fax: 304.243.5047
White River Junction Veterans Affairs Medical Center (VAMC)
215 North Main Street
White River Junction, Vermont 05009
Phone: 866.687-8387
Fax: 802.291.6261
Yale Comprehensive Cancer Center, Department of Therapeutic Radiology
333 Cedar Street, PO Box 208040
New Haven, Connecticut 06520
Phone: 203.785.4095
Fax: 203.788.4116
Treatment Type
The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments. Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology.
Surgery
Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy
Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
This technique is also used in patients with malignant pleural mesothelioma.
Multimodality Therapy
All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors. However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years). Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma. Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation. Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.
