About Dr. Fontaine
Dr. Jacques Fontaine is board certified by the American Board of Surgery and the American Board of Thoracic Surgery. He currently practices Thoracic and GI Oncology at H. Lee Moffitt Cancer Center in Tampa, Florida.Make an Appointment
The top treatment approach for mesothelioma combines surgery with chemotherapy and radiation. Clinical trials are testing improvements in these traditional cancer treatments as well as new technologies such as immunotherapy.
Each mesothelioma patient’s treatment plan depends on their cancer stage and their overall health.
For early-stage patients in strong health, doctors recommend a multimodal approach. This combines therapies that kill cancer cells in different ways. It gives mesothelioma patients the best chance of long-term survival.
Patients who are not eligible for surgery may still benefit from treatments such as chemotherapy, radiation and immunotherapy. These treatments can relieve cancer symptoms, restore quality of life and sometimes extend survival as well.
Mesothelioma specialists can use two procedures to remove tumors from the chest:
- Extrapleural pneumonectomy removes the affected lung and all surrounding tissues where the cancer has spread.
- Pleurectomy and decortication removes all the cancerous tissue around the lung, but it leaves the lung in place.
Both procedures are challenging and highly invasive, requiring an expert thoracic surgeon. Fortunately, the da Vinci Surgical System has made mesothelioma surgery safer for patients.
Advantages of Robotic Surgery
Using the remote-control da Vinci robot, a mesothelioma surgeon can look inside a patient’s chest with a tiny 3D camera before they make a large incision.
- First, this allows the surgeon to decide whether they should go through with the surgery. If the cancer has spread farther than imaging scans made it appear, major surgery would do more harm than good.
- Next, the surgeon can decide whether the patient’s lung needs to be removed to successfully eliminate the tumor growth. Removing a lung leads to a permanent loss of stamina for the patient, but it may be the only way to eliminate the whole tumor.
- Finally, the fine robotic tools of the surgery robot enable the surgeon to minimize blood loss when they make the main incisions. This leads to a safer operation and a shorter recovery period for the patient.
The surgery robot provides a magnified view of the surgery area, and its miniature robotic arms allow the surgeon to make extremely precise movements. However, it takes extensive training to use the robot, and the technology is expensive to acquire.
The Moffitt Cancer Center is among the top medical centers in the Tampa Bay region equipped with the da Vinci Surgical System. Dr. Fontaine is one of the nation’s leading experts on using it for complex chest procedures.
The most common treatment for mesothelioma is a two-drug chemotherapy regimen. Doctors usually pair pemetrexed (Alimta) with a platinum-based drug such as cisplatin or carboplatin. The drugs are delivered through an IV once every few weeks for a certain number of months.
In 2004, this combination became the first — and so far only — FDA-approved treatment for mesothelioma. To improve outcomes for mesothelioma patients, the Moffitt Cancer Center conducts clinical trials to test new drugs and new methods of drug delivery.
In 2015, Moffitt began to test transarterial chemoperfusion for mesothelioma patients who were ineligible for surgery.
In this technique, doctors only inject chemotherapy into the specific blood vessels feeding the tumor. This allows doctors to target the cancer with high-dose chemotherapy and without causing dangerous side effects throughout the rest of the patient’s body.
Chemotherapy with ADI-PEG 20
In 2017, Moffitt opened a clinical trial for patients with the rare sarcomatoid and biphasic subtypes of mesothelioma. These subtypes are resistant to standard treatments and spread more aggressively.
Experts believe an experimental drug called ADI-PEG 20 could boost the effectiveness of chemotherapy. This would give patients with sarcomatoid or biphasic mesothelioma a better chance of response.
Radiation therapy uses high-energy particles or waves to kill cancer cells. However, mesothelioma forms close to sensitive vital organs such as the heart and lungs. It takes a team of experienced specialists to safely administer radiation for mesothelioma.
Doctors may use radiation to shrink tumors before surgery or reduce the risk of recurrence after surgery. Doctors may also prescribe radiation on its own to relieve chest pain for mesothelioma patients.
Immunotherapy treatments are designed to help a patient’s natural immune system recognize and destroy cancer cells. Recent advances in this technology have generated great excitement in the cancer treatment field.
The FDA has approved immunotherapy drugs such as pembrolizumab (Keytruda) and nivolumab (Opdivo) for lung cancer. Specialists believe immunotherapy has the potential to benefit mesothelioma patients as well.
Because the side effects of immunotherapy are usually mild, it can be combined with surgery and chemotherapy. It can also be given on its own to patients who aren’t eligible for more aggressive treatments.
For many years, the Moffitt Cancer Center has participated in immunotherapy clinical trials for mesothelioma.
Immunotherapy Treatments Investigated at Moffitt
- BAY 94-9343: antibody that targets the protein mesothelin. This protein is commonly overexpressed in mesothelioma cells.
- CRS 207 Cancer Vaccine: uses genetically modified bacteria to produce an anti-tumor response.
- CRS 207 Plus Pembrolizumab: combines a cancer vaccine with an immune checkpoint inhibitor that binds to PD-L1 proteins. Cancer cells can use PD-L1 to hide from the body’s immune system.
- Nivolumab Plus Ipilimumab: combines two immune checkpoint inhibitors to increase immune system activity against cancer cells. Nivolumab binds to PD-L1 proteins, and ipilimumab binds to CTLA-4 proteins.