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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.

What Are the Different Types of Chemotherapy Drugs?

Although chemotherapy drugs for mesothelioma all work in different ways, their general purpose is to damage or kill the cancer cells, in turn preventing them from dividing uncontrollably. In some forms of cancer, the chemotherapy drugs completely kill all the cells, but for mesothelioma patients, chemotherapy is often most effective at controlling the growth of tumors.

That National Cancer Institute outlines four common classes of chemotherapy drugs:

Alkylating agents: These types of drugs act directly on DNA to prevent cells from dividing. Alkylating agents, which can kill cells whether they are in the process of dividing or in a resting state, are generally most effective in treating slow-growing cancers.

Antimetabolites: Antimetabolites mimic the nutrients that cells need to grow, thereby tricking the cancer cells into consuming them and eventually causing the cells to starve to death due to lack of nutrients. Antimetabolites primarily act on cells that are undergoing synthesis of new DNA for the formation of new cells.

Plant alkaloids: These antitumor agents, which are derived from plants, also work by blocking the cancer cells from dividing and becoming two cells. These drugs are most effective when the cancer cells are in the process of separating and synthesizing their DNA.

Antitumor antibiotic: These types of drugs cause the strands of genetic material that make up DNA to uncoil, thereby preventing the cancer cell from reproducing. It is important to note that these are not the same types of drugs that are used as antibiotics common in treating bacterial infections.

In addition to the standard types of chemotherapy drugs, targeted immunotherapy for mesothelioma is emerging as another alternative treatment. This type of treatment aims to use the body’s own immune system to fight off the cancer cells.

What Are the Common Chemotherapy Drugs for Mesothelioma?

So far, the Food and Drug Administration has only approved the chemotherapy drugs pemetrexed and a combination of gemcitabine and cisplatin for treatment of mesothelioma. However, even though a chemotherapy drug or a specific drug combination has not yet been approved by the FDA as a mesothelioma treatment, your doctor may still consider it an option for you.

There are actually several chemotherapy drugs that can be used to treat mesothelioma, according to the American Cancer Society. These include:

  • Pemetrexed (Alimta)
  • Cisplatin (Platinol, Platinol-AQ)
  • Carboplatin (Paraplatin)
  • Gemcitabine (Gemzar)
  • Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
  • Vinorelbine (Navelbine)
  • Mitomycin (Mutamycin)
  • Doxorubicin (Adriamycin, Rubex)

Your doctor may opt to use one or a combination of chemotherapy drugs in the first set of treatment cycles, also known as first-line therapy. If that first-line therapy does not have the intended effect, a second-line therapy may be recommended. In this second round of chemo, your doctor may consider using a different drug or drug combination.

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.

What Chemotherapy Drug Combinations Are Used for Mesothelioma?

Chemotherapy drug combinations are commonly used to help boost the effectiveness of mesothelioma treatment. These combinations generally include two chemotherapy drugs that may act on cancer cells in different phases of the cells’ development.

The most common chemotherapy drug combination used to treat mesothelioma is pemetrexed and cisplatin.

However, other combinations include:

  • Pemetrexed and carboplatin
  • Pemetrexed and gemcitabine
  • Carboplatin and gemcitabine
  • Cisplatin and gemcitabine
  • Cisplatin and doxorubicin
  • Cisplatin and mitomycin
  • Cisplatin and vinorelbine

It’s important that patients talk to their doctors about all their treatment options, including what chemotherapy drug combinations for mesothelioma are being studied as part of clinical trials. The landscape for mesothelioma treatment options is constantly changing, and chemotherapy is a field that could see great strides and give hope to many patients in the future.

Chemotherapy Side Effects

The side effects of chemotherapy can be hard on a mesothelioma patient, especially considering that most people are diagnosed with the cancer at an older age. Your doctor will take into account your age and general health in determining which chemotherapy drugs or drug combinations may work best for you and what side effects you may or may not be able to tolerate. icon-3

It is also important to note that everyone reacts differently to chemo, so you may not experience all (or any) of the side effects listed.

Chemotherapy Drug Brand Name(s) How It’s Given Most Common Side Effects
Pemetrexed Alimta Injection/IV
  • Low white blood cell count
  • Low red blood cell count
  • Fatigue
  • Nausea and vomiting
  • Constipation
  • Poor appetite
  • Shortness of breath
  • Chest pain
Cisplatin Platinol, Platinol-AQ IV or infusion into the abdominal cavity (intraperitoneal)
  • Nausea and vomiting
  • Kidney toxicity
  • Blood test abnormalities (low magnesium, low calcium, low potassium)
  • Low white blood cell count
  • Low red blood cell count
Carboplatin Paraplatin IV or infusion into the abdominal cavity

 

  • Low blood counts (including red blood cells, white blood cells and platelets)
  • Nausea and vomiting
  • Taste changes
  • Hair loss
  • Weakness
  • Blood test abnormalities (magnesium levels)
Gemcitabine Gemzar IV
  • Flu-like symptoms
  • Fever
  • Fatigue
  • Nausea (mild)
  • Vomiting
  • Poor appetite
  • Skin rash
  • Low blood counts
  • Temporary increases in liver enzymes
  • Blood or protein in the urine
Methotrexate

 

Otrexup, Rasuvo, Rheumatrex, Trexall IV, injection into the muscle (IM), pill
  • Low blood counts
  • Mouth sores
  • Poor appetite
Vinorelbine Navelbine IV
  • Low blood counts
  • Nausea or vomiting
  • Muscle weakness
  • Constipation
Mitomycin

 

Mutamycin IV
  • Low blood counts
  • Mouth sores
  • Poor appetite
  • Fatigue
Doxorubicin Adriamycin, Rubex IV
  • Pain along the site where the medication was given
  • Nausea or vomiting
  • Low blood counts
  • Hair loss

In addition to these more common side effects, some patients may experience other reactions to chemotherapy drugs. It is important that you talk to your doctor about what to expect from the chemo treatment you are undergoing. And always tell your medical team about the side effects you are experiencing so they can adjust your chemotherapy regimen if needed.

How Long Do Chemotherapy Drugs Stay in Your System?

The drugs themselves do not stay in your system for very long. However, the side effects can take time to dissipate. The amount of time it takes for side effects to subside really varies from person to person. If you are concerned about how long your chemotherapy side effects have been lingering, discuss your concerns with your doctor.

Keep in mind that although the effects of chemotherapy can be difficult to cope with in the short term, the goal of the treatment is to fight the mesothelioma, prolong your life, and make you feel better in the long run. And remember, you are not along in this fight. There is a community of mesothelioma survivors, caregivers and medical professionals here to lean on.

Deciding What Type of Chemo Is Right for You

If you or a loved one has been diagnosed with mesothelioma, it is important that you seek treatment advice from a medical professional who specializes in this specific type of cancer. In addition to understanding what chemotherapy drugs for mesothelioma are traditionally given, a specialist will also be able to discuss you options for pursuing clinical trials and alternative treatment methods.

If you need help finding a doctor or have any questions related to mesothelioma treatment options, contact us today. We are here to give patients the information they need, the help they deserve, and the hope that will sustain them through this difficult process.

  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 https://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
  15. ChemoCare.com: Chemotherapy Drugs and Drugs Often Used During 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: Sep 20, 2016
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