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Treating Mesothelioma: Reviewing Multiple Treatment Modalities” Or “Multiple Treatment Modalities Offered at Certain Clinic to Treat Mesothelioma”

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Treating Mesothelioma: Reviewing Multiple Treatment Modalities” Or “Multiple Treatment Modalities Offered at Certain Clinic to Treat Mesothelioma” Evidence-Based Practice Group Answers to Clinical Questions “Treating Mesothelioma: Reviewing Multiple Treatment Modalities” or “Multiple Treatment Modalities Offered at Certain Clinic to Treat Mesothelioma” A Rapid Systematic Review By WorkSafeBC Evidence-Based Practice Group Dr. Craig Martin Manager, Clinical Services Chair, Evidence-Based Practice Group January 2016 Clinical Services – Worker and Employer Services Treating Mesothelioma: Reviewing Multiple Treatment Modalities i About this report “Treating Mesothelioma: Reviewing Multiple Treatment Modalities” or “Multiple Treatment Modalities Offered at Certain Clinic to Treat Mesothelioma” Published: January 2016 About the Evidence-Based Practice Group The Evidence-Based Practice Group was established to address the many medical and policy issues that WorkSafeBC officers deal with on a regular basis. Members apply established techniques of critical appraisal and evidence-based review of topics solicited from both WorkSafeBC staff and other interested parties such as surgeons, medical specialists, and rehabilitation providers. Suggested Citation WorkSafeBC Evidence-Based Practice Group, Martin CW. Treating Mesothelioma: Reviewing Multiple Treatment Modalities” or “Multiple Treatment Modalities Offered at Certain Clinic to Treat Mesothelioma. Richmond, BC: WorksafeBC Evidence-Based Practice Group; January 2016. Contact Information Evidence-Based Practice Group WorkSafeBC PO Box 5350 Stn Terminal Vancouver BC V6B 5L5 Email [email protected] Phone 604 279-7417 Toll-free 1 888 967-5377 ext 7417 View other systematic reviews by the EBPG online at: http://worksafebc.com/evidence WorkSafeBC Evidence-Based Practice Group January 2016 www.worksafebc.com/evidence Treating Mesothelioma: Reviewing Multiple Treatment Modalities 1 Objective To determine whether there is evidence on the efficacy or effectiveness and safety of the treatment modalities for mesothelioma offered at some centres in the United States. These treatments include genetically targeted fractionated chemotherapy, autologous adoptive immunotherapy, natural killer cell vaccine, intravenous nutrition therapy, oxidative therapy and biodetoxification. Methods • A systematic literature search was conducted on September 23, 2013. • The search was done on commercial medical literature databases, including Cochrane Database of Systematic Reviews®, ACP Journal Club®, Database of Abstracts of Reviews of Effects®, Cochrane Central Register of Controlled Trials®, Health Technology Assessment®, NHS Economic Evaluation Database®, BIOSIS Previews®, Embase®, International Pharmaceutical Abstracts®, MEDLINE®, MEDLINE In- Process & Other Non-Indexed Citations®, MEDLINE Daily Update® and OLDMEDLINE®, that are available through OvidSP® platform. • The search was done from the inception date of each database to September 23, 2013. • No limitations, such as on publication language or date of publication, were implemented in these searches. • In order answer to this review’s stated objective, the searches were done in several stages by employing the following keywords combintations or author's name(s): o (envita medical centers of America) or (envita medical centers) or envita. No published study done at this clinic or by authors affiliated with this clinic was found. o prato.au. OR (korn or korn b).au. According to the information available on the Envita website (http://www.envita.com/), Dino D. Prato, ND (naturopath), is the founder and CEO of the Envita Clinic. Based on claims of success in treating numerous types of diseases (from on information on the clinic’s website), we expected to see a number of publications of studies/study WorkSafeBC Evidence-Based Practice Group January 2016 www.worksafebc.com/evidence Treating Mesothelioma: Reviewing Multiple Treatment Modalities 2 results in formal, peer-reviewed medical journals that may be attributed to the Envita clinic or by the founder/clinicians affilitated with the clinic. By employing the last name of the clinic's founder (Prato) as well as the last name of other physicians at the clinic, 286 (ref. 1-286) published studies were identified through this search. However, upon examination of the titles and abstracts of these 286 articles (ref. 1-286) none of these studies were relevant to the objective of this systematic review. o (genetically targeted fractionated chemotherapy) OR (genetically matched chemotherapy). No published study on the topic of genetically targeted fractionated chemoteraphy was identified. o (autologous adoptive immunotherapy). Twenty (ref. 287-297) published studies were identified by employing this keyword combination. Upon examination of the titles and abstracts of these 20 studies (ref. 287-297), none of these studies were relevant to answering the objective of this systematic review. o (natural killer cell vaccine). Three (ref. 298-300) published studies were identified through this search. However, upon examination of the titles and abstracts of these papers, none were relevant to answering the objective of this systematic review. o (intravenous nutrition therapy). Nine (ref. 301-309) published studies were identified through this search. However, none of these nine articles (ref. 301-309) were relevant in answering our objective. o (((oxidative therapy) OR biodetoxification) AND mesothelioma). No published study was identified through this search. WorkSafeBC Evidence-Based Practice Group January 2016 www.worksafebc.com/evidence Treating Mesothelioma: Reviewing Multiple Treatment Modalities 3 Results • At present, there are no published studies identified regarding the efficacy or effectiveness of the treatments (genetically targeted fractionated chemotherapy, autologous adoptive immunotherapy, natural killer cell vaccine, intravenous nutrition therapy, oxidative therapy and biodetoxification) proposed by the Envita clinic to treat patients diagnosed with mesothelioma. As such, it is not possible to assess the efficacy/effectiveness, or safety, of these treatment modalities. • Through daily literature surveillance, which includes literature on the topic of mesothelioma, the Evidence-Based Practice Group possess two recent, high quality systematic reviews (level of evidence 1. Appendix 1) investigating the effectiveness of different chemotherapy and immunotherapy regimens for patient with mesothelioma (ref. 310) and an evidence-based guideline for the diagnosis and treatment of malignant pleural mesothelioma (ref. 311-313). These two high quality level 1 evidence are as follows: 1. Berghmans et al. (ref. 310) conducted a meta-analysis investigating the effectiveness of various chemo- and immunotherapies in treating patients diagnosed with malignant mesothelioma. 2. The Asbestos Diseases Research Institute of Australia (ADRI) (ref. 311-313) developed a high quality, evidence-based, comprehensive guideline on the management of malignant pleural mesothelioma. • With regard to the role of immunotherapy in treating mesothelioma patients, both the Berghmans and ADRI studies stated that there was no evidence supporting the effectiveness of immunotherapy and the modality should only be used in experimental studies. • The comprehensive and evidence-based ADRI guidelines are the most up to date guidelines available. They emphasize the importance of having a multidisciplinary team involved in the management of patients diagnosed with mesothelioma. Below are some (and perhaps the most) important aspects on the management of patients with mesothelioma: o A multidisciplinary team approach will ensure consistency in patient management through the development of a multidisciplinary care plan that will guide patient treatment throughout their illness and provide support for their caregivers. WorkSafeBC Evidence-Based Practice Group January 2016 www.worksafebc.com/evidence Treating Mesothelioma: Reviewing Multiple Treatment Modalities 4 Allied health professionals are important members of the multidisciplinary team and contribute to symptom management and improved quality of life in patients with malignant mesothelioma. Current practice tells us that allied health professionals are integral members of multidisciplinary team and may come from the following disciplines: nutrition and dietetics, occupational therapy, social work, clinical psychology, physiotherapy and pastoral care. Patients can be referred to these professionals at any time during their disease course and treatment trajectory. However, at present, no studies have been conducted on the impact of allied health professional input on the outcomes for patients with malignant pleural mesothelioma. o Combination chemotherapy (pemetrexed and cisplatin or carboplatin) rather than single drug treatment should be used as first-line systemic treatment for malignant pleural mesothelioma. o Thoracoscopic pleurodesis is an effective treatment option to control recurrent malignant pleural effusions in mesothelioma. If the thoracoscopic pleurodesis is not appropriate or fails, palliative pleurectomy/decortication should be considered for symptom control. o Only patients with favourable prognostic features, and favourable histology and staging, should be referred for consideration of radical treatment involving extensive cytoreductive surgery. o Radical surgical approaches should only be done at institutions with significant surgical experience and a high volume of cases. Extensive cytoreductive surgery should only be used as one element of a multimodality treatment plan. o Mesothelioma is sensitive to moderately
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