While the recommended mesothelioma treatment will no doubt vary from patient to patient and doctor to doctor, the form of cancer treatment most widely suggested is chemotherapy.
Dealing with the idea of chemotherapy can be equally as frightening as the initial diagnosis of mesothelioma. Chemo conjures up thoughts of horrible side affects and often leave the patient feeling worse than if they had no treatment at all. However, because advances in chemotherapy drugs and medications to lessen the side affects have decreased some of the unpleasant effects of chemo, patients should remain open to the idea of undergoing this type of treatment and consider all options doctors/a> may present them with.
How Does Chemotherapy Help?
Quite simply, chemotherapy - treatment with a specific cancer drug or combination of drugs - kills cancer cells. Unlike surgery and radiation therapy, which can destroy cancer cells in one particular location, chemotherapy can be used to destroy cells that have metastasized - or spread to other parts of the body.
There are currently about 100 chemotherapy drugs on the market. Though single chemo drugs are sometimes used to treat a particular type of cancer, more often a few of these drugs are used in tandem. This is called combination chemotherapy. Some combinations have proved more helpful than others in fighting mesothelioma and its troublesome symptoms. Because all of these drugs work a bit differently, your oncologist will determine which are best suited to treating your disease. The doctor will also be able to determine the length of your course of treatment as well as the frequency of treatments.
Types of Chemotherapy
Chemotherapy is received either by means of a pill or intravenously via a needle in the vein. Chemotherapy drugs may be administered 1) systemically - which means that the drugs are carried through the blood stream; or 2) intrapleurally - injected directly into the site of the tumor, with in the case of mesothelioma is usually the pleura, the lining of the lung. Doctors have had some success with both methods.
Chemotherapy for Mesothelioma
Mesothelioma is a very aggressive form of cancer, so doctors treat it as aggressively as possible. That includes the use of highly toxic chemo drugs that will, hopefully, help destroy cancer cells while also providing some relief from the bothersome side affects of the disease, such as coughing, shortness of breath, and chest pain.
Years ago, doctors opted for single chemotherapy treatments for the disease. Unfortunately, they yielded little more than approximately a 15% success rate, providing minimal relief to the mesothelioma patient. More recently, oncologists and research scientists have determined that the best way to fight mesothelioma is through combination chemotherapy.
Currently, the drugs of choice are a newer drug, Alimta (pemetrexed), combined with Cisplatin, which has been on the market for some time. As a matter of fact, Alimta, when given with cisplatin, is the first and only chemotherapy drug to be approved by the Food and Drug Administration (FDA) for the treatment of patients with malignant pleural mesothelioma when surgery is not an option.
Other common chemotherapy drugs used to treat mesothelioma include gemcitabine, vinorelbine, and onconase. Researchers continue to experiment with new drugs and new combinations of chemotherapy medications in hopes that they can find the best available to treat the disease and its symptoms.
What to Expect
Chemotherapy is not a miracle drug, especially where mesothelioma is concerned, so it's necessary to be patient when dealing with the treatment. Most patients receiving chemotherapy for the first time will be especially concerned about side effects. Different chemotherapy drugs have different side effects, but your doctor should be able to tell you what to expect.
Because your doctor has experience with specific chemotherapy drugs, he/she may also be able to tell you when to expect the side effects, how long they'll last, and what to do about them. These days, there are many options available to help minimize or avoid these side effects so the chemotherapy of today is much different than that of decades or even years ago. Remember, also, that most of these side effects will disappear when the treatment has ended. Doctors can also advise patients on clinical trials experimenting with trial-phase drugs.
The most common chemotherapy side effects include:
- Low white blood cell count (which leaves you prone to infection)
- Loss of appetite
- Fever and chills
- Low platelet count (which may cause problems with clotting)
- Generalized achy-ness
- Tingling hands and feet
It's important to tell your doctor about any side effects you might experience, even if they are noted as "common" side effects of your chemotherapy. High fever, inability to eat or drink, blood in the stool or urine, and signs of infection should be addressed immediately. Your doctor will inform you about other side effects which he/she considers life-threatening.
Chemotherapy Drugs & Fact Sheets
Alimta (pemetrexed) holds the distinction of being the only FDA approved chemotherapy regimen for the treatment of malignant pleural mesothelioma. Alimta is typically used in conjunction with a platinum agent such as cisplatin.
Alimta is administered in 21-day cycles. The duration of the cycle as well as how many subsequent cycles are administered depends on the effectiveness of the chemotherapy in the individual patient. Alimta is not appropriate for all patients undergoing mesothelioma chemotherapy. Those interested should view our more comprehensive Alimta information and speak with their cancer treatment specialist.
Originally designed for patients undergoing treatment for lung cancer and ovarian cancer, Carboplatin has at least been trialed in patients undergoing mesothelioma chemotherapy treatment. Carboplatin is from a family of drugs known as alkalizing agents, with its parent drug, cisplatin, being more popular in mesothelioma treatments.
Carboplatin is most often utilized with other chemotherapy drugs, with the most common being GEMzar (gemcitabine). Carboplatin is often used as an alternative to cisplatin, as carboplatin is known to carry fewer side-effects. If you would like more information about carboplatin or other mesothelioma chemotherapy drug, fill out the brief form on this page and we’ll rush you a complimentary information packet about mesothelioma and mesothelioma treatment options.
Cisplatin, approved by the FDA in the late 1970s, is what is known as a platinum compound or alkalizing agent. Alkalyzing agents are most often used in conjunction with other chemotherapy drugs, maximizing the primary drug’s efficacy while limiting side effects.
Cisplatin has, in the past, been used not only for mesothelioma chemotherapy, but also the treatment of stomach, lunch, testicular, and bladder cancers. Cisplatin for mesothelioma is most commonly combined with Alimta (pemetrexed). The combination of these two drugs represents the only FDA-approved chemotherapy regimen for the treatment of malignant pleural mesothelioma, even as many others are currently in various trial approval staging.
Gemcitabine is what is known as an anti-metabolite, a classification given to agents which prevent RNA and DNA production within cells. Preventing cell multiplication by interfering with the synthesis of nucleic acids, gemcitabine can prevent cell growth and slow tumor spread. Occasionally used in mesothelioma chemotherapy regimens, gemcitabine is more commonly used fin the treatment breast, lung, and pancreatic cancers.
Gemcitabine is a weekly-cycle chemotherapy agent, with injection taking approximately 30 minutes. Duration of treatment will depend on a number of different factors including, but not limited to, general patient health, type of malignancy being treated, and the stage of the malignancy at the onset of treatment. Gemcitabine is not for use by all mesothelioma patients, your cancer specialist and oncologist can provide you with further information if you may be a candidate for Gemcitabine chemotherapy.
Navelbine (vinorelbine) is a type of chemotherapy drug that is classified as a plant alkaloid. These types of drugs prevent cells from separating to form to new cells, thus slowing cancer cell production and spread. Navelbine is currently only in trial phase for treatment of malignant mesothelioma but has thus far shown encouraging results as an emerging mesothelioma chemotherapy agent.
Early trials show Navelbine affecting approximately 25% of mesothelioma patients, a number that while low, still represents nearly a 5% improvement over most other mesothelioma chemotherapy drugs. Navelbine is currently available by both injection and capsule form. Your doctor or cancer specialist will assist in determining the correct dosage of navelbine depending on the stage of the cancer, the type of cancer, and the general health of the patient.
Onconase (ranpirnase) is produced by the Alfacell Corporation and is currently in clinical trial stageing. Onconase is a ribonuclease protein that is intended to be taken in conjunction with more traditional chemotherapy drugs. Ribonuclease proteins enhance the cancer-defeating capacities of traditional drugs in smaller dosages, thus limiting side effects. Lower toxicity levels will usually equate to a milder set of side effects associated with mesothelioma chemotherapy drugs such as Alimta.
Tumor response levels have thus far been encouraging, with approximately 50% of patients demonstrating tumor loss or halt of growth. Onconase is also being tried as a preventative measure against tumor growth, producing a vaccine-like effect in those at risk of developing malignant mesothelioma.
- American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_29.asp?sitearea
- National Cancer Institute, Malignant Mesothelioma: General Information. http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/healthprofessional
Last modified: April 19, 2011.