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chemotherapy Chemotherapy is the use of drugs to treat cancer. Along with radiation therapy and surgery, chemotherapy is one of the conventional treatment options for malignant mesothelioma. Not all patients are healthy enough for chemotherapy. The decision to undergo chemotherapy—as well as other considerations such as which chemo drugs are right for you, how the drugs are delivered, the duration of treatment, and whether chemo will be used alone or with other therapies—will be made with guidance from a medical oncologist and based on your functional status.

How Chemotherapy Works

Cell division is a normal part of normal tissue function. Normal cells divide and proliferate according to a genetically controlled process. Cancer cells, on the other hand, are the result of mutations and do not behave as normal cells do. They divide rapidly and uncontrollably and group together to form tumors. Chemo drugs target rapidly-dividing cells. This includes not only cancer cells but also healthy cells, which is why chemotherapy produces side effects. But cancer cells divide with much greater frequency than most normal cells and are more likely to be affected by chemotherapy. Although different chemotherapies work in somewhat different ways, the drugs’ general mechanism of action involves damaging the genes of cancer cells, thus stopping them from dividing uncontrollably and shrinking tumors. Ideally, chemotherapy kills all cancer cells, but in the case of mesothelioma, it more often helps to temporarily control tumor growth. A newer class of chemotherapies known as targeted therapies hone in on specific molecules within cancer cells, rather than acting against all dividing cells. While targeted chemo drugs affect the body differently than standard chemo drugs, they can still produce side effects. Targeted therapies for mesothelioma are still in the developmental stages, but interested patients may be able to undergo treatment with them in a clinical trial.

Undergoing Chemotherapy

The information presented below is intended to inform you about chemotherapy for malignant mesothelioma. It is not a substitute for professional medical advice. We can, however, put you in touch with the country’s top mesothelioma specialists.

Multimodal Therapy

Chemotherapy on its own is unlikely to completely eradicate mesothelioma, but chemo can slow the progression of mesothelioma, alleviate symptoms, and improve quality of life. This type of chemotherapy is known as palliative chemotherapy. Combined with surgery (either before or after a pleurectomy/decortication or extrapleural pneumonectomy) chemotherapy is potentially curative. In fact, some patients have been declared cancer free after surgery and chemotherapy, although this outcome is rare. The use of two or more of chemotherapy, radiation therapy, and surgery is called multimodal therapy. Specialists may recommended the use of all three treatments, or trimodal therapy.

Neoadjuvant and Adjuvant Chemotherapy

Neoadjuvant chemotherapy is chemotherapy given before surgery. Pre-surgical chemo can shrink mesothelioma tumors, treat cancer that has spread to the lymph nodes, and may permit less invasive surgery. Adjuvant chemotherapy is chemotherapy given after surgery. The goal of post-surgical chemo is to destroy cancer cells that the surgeon may have missed and prevent the cancer from coming back.

Drug Types

There are several drugs available that can treat malignant mesothelioma, but only cisplatin (Platinol and Platinol-AQ) and pemetrexed (Alimta) are FDA-approved by the Federal Drug Administration for mesothelioma. Research has shown that using a combination of cisplatin and pemetrexed delivers the best results for patients with mesothelioma, and this combination therapy (the use of more than one chemotherapy drug) is a standard treatment. Patients who use pemetrexed and cisplatin typically report an improved quality of life, and studies have shown that this drug combination is likely to increase life span more than any other current chemotherapy treatment. Pemetrexed, however, lowers B12 and folic acid levels, so patients typically take these supplements along with the drugs to help avoid side effects.

Chemotherapy Cycles

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Pemetrexed and cisplatin chemotherapy is typically administered in 4-6 cycles, with a recovery period of three weeks between cycles. The drugs are delivered intravenously through a short thin tube in your arm or hand (a cannula), a fine tube under the skin of your chest (a port, or portacath), or a fine tube put into a vein in your arm that connects to a vein in your chest (PICC line). Initial chemotherapy cycles are called first-line therapy.

If mesothelioma recurs or progresses following first-line chemotherapy, second-line therapy, or additional cycles of chemotherapy drugs, might be recommended. The same drug regimen that was used for first-line therapy may be used for second-line therapy, or a new regimen may be introduced. When cancer drugs are delivered intravenously, they travel throughout the body and attack cancer cells in many locations. This is known as systemic chemotherapy.

Intrapleural and Intraperitoneal Chemotherapy

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Not all chemotherapy is systemic. In some cases, heated drugs are delivered directly to the site of the cancer after cancerous cells have been removed, but while the patient is still in surgery. This warm bath of chemo drugs sends a more intense dose of chemotherapy directly to where its needed.

Intrapleural chemotherapy is the use of heated chemo drugs following a pleurectomy or extrapleural pneumonectomy (EPP). Heated intraperitoneal chemotherapy (HIPEC) is given to peritoneal mesothelioma patients after all visible abdominal tumors are removed. Research has shown that cancer cells respond better to higher temperatures. The drugs most often used for hyperthermic chemotherapy are mitomycin or a combination of doxorubicin and cisplatin.

Chemotherapy Side Effects

Because chemo drugs target rapidly-dividing cells, they can affect healthy cells in the body that divide often, including those in bone marrow and the lining of the mouth and intestines. That’s why common side effects of chemotherapy include nausea, vomiting, and mouth sores. Fortunately, chemotherapy side effects are typically short-lived and disappear after the treatment is complete. Other side effects commonly reported by patients undergoing chemo include: icon-3 There are medicines available that can mitigate these side effects. Patients should discuss any side effects with their medical team so that they can be properly managed.

  1. American Cancer Society. Chemotherapy for Malignant Melanoma. Retrieved from http://www.cancer.org/cancer/malignantmesothelioma/detailedguide/malignant-mesothelioma-treating-chemotherapy
  2. American Cancer Society: Questions about chemotherapy
  3. Center for the Advancement of Health. Mesothelioma: Chemo Combination Improves Survival In Asbestos-related Cancer. ScienceDaily, 11 February 2007. Retrieved from http://www.sciencedaily.com/releases/2007/02/070208131638.htm
  4. Mayo Clinic. Diseases and Conditions: Mesothelioma. Retrieved from http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/definition/con-20026157
  5. Texas Oncology. Stage I-III Malignant Pleural Mesothelioma. Retrieved from http://www.texasoncology.org/types-of-cancer/mesothelioma/stage-i-iii-malignant-pleural-mesothelioma/
  6. Annals of Cardiothoracic Surgery: Chemotherapy for malignant pleural mesothelioma: a review of current management and a look to the future
  7. National Cancer Institute: Cancer.gov – Malignant Mesothelioma Treatment
  8. Cancer Research UK: How chemotherapy works
  9. National Center for Biotechnology Information: How does chemotherapy work?
  10. Nature: Cell Division and Cancer
  11. Cancer Immunology, Immunotherapy: CTLA4 blockade in mesothelioma: finally a competing strategy over cytoxic/target therapy?
  12. Dovepress: New and emerging therapeutic options for malignant pleural mesothelioma: review of early clinical trials
  13. Recent Results in Cancer Research: What is Perioperative Chemotherapy?
  14. Macmillan Cancer Support: Pemetrexed and cisplatin chemotherapy

About the Author - 

Lisa Hyde-Barrett has helped ease the stress of patients and their families by offering a comforting hand. Lisa has 25 years of experience as a thoracic surgery nurse. She is passionate about helping the mesothelioma community.

Published: Jun 18, 2014 - Updated: Oct 26, 2015
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