Chemotherapy

Chemotherapy is one of three conventional treatments for mesothelioma, along with surgery and radiation. It is often used as part of a multimodal treatment plan.

Key Points

  • 1

    Chemotherapy is the standard treatment for most cases of mesothelioma.

  • 2

    Alimta and cisplatin is the most common combination used to treat mesothelioma.

  • 3

    Chemotherapy can have a number of mild to more severe side effects.

  • 4

    Chemotherapy can extend life expectancy on average between 12 and 16 months.

Chemotherapy is a standard mesothelioma treatment, recommended to patients with all types of the rare cancer. While chemotherapy cannot cure mesothelioma and is typically associated with a number of unpleasant side effects, it can kill cancer cells, thereby reducing symptoms and improving quality of life, as well as potentially extending life expectancy. Chemotherapy may be used as a first-line therapy on its own, or applied in combination with surgery and/or radiation therapy.

Mesothelioma Chemotherapy Success Rate

Though chemotherapy is considered the standard of care for most mesothelioma cases, patients have seen mixed results. A treatment study found that of pleural mesothelioma patients treated with chemotherapy alone, only about 19% survived two years after diagnosis. After five years, a mere 4% of these patients were still alive. The study found patients who underwent cytoreductive surgery, typically part of a multimodal approach, achieved much better survival rates than chemotherapy by itself, with about 40% surviving two years and 10% – 12% surviving five years.

Peritoneal mesothelioma patients, however, have seen greater success with a specific kind of chemotherapy for mesothelioma combined with surgery. Cytoreductive surgery followed by a heated chemotherapy wash, hyperthermic intraperitoneal chemotherapy or HIPEC, in the abdominal cavity has shown a 5-year survival rate as high as 67%. For patients where surgery and HIPEC aren’t an option, chemotherapy combinations used for pleural mesothelioma may be an option, showing an average survival of 12 – 27 months.

It’s important to keep in mind the success and efficacy of chemotherapy can vary greatly between patients due to a number of factors, like cell type or a patient’s overall health. The success of chemotherapy will also vary depending on the type of chemotherapy drugs and how the chemotherapy is applied.

Get the Latest Mesothelioma Chemotherapy Updates

How Chemotherapy Treats Mesothelioma

In general, chemotherapy can be used curatively in the hopes of achieving remission by killing cancer cells or applied palliatively to reduce symptoms and improve quality of life. When applied curatively, the main goal of chemotherapy is to attack and kill rapidly dividing cancer cells. Unfortunately, it can also kill other fast-growing cells, leading to certain side effects like hair loss. Chemotherapy can also be used to shrink tumors, which helps to alleviate common symptoms. Unlike surgery and radiation, which target a particular location, chemotherapy destroys cells that have spread throughout the body.

Chemotherapy drugs are administered in two ways, which depend on the type and stage of mesothelioma, the patient’s overall health and the type of drug(s) being used.

How Chemotherapy Drugs are Administered
Systemic

Drugs are carried through the bloodstream after being swallowed in pill form or injected intravenously (through an IV). Typically, chemotherapy drugs are available in pill form only during clinical trials.

Intraoperative

Drugs are injected directly at the site of the tumor, where it saturates the area containing the cancer and kills cells that may be left after surgery. Intraoperative chemotherapy drugs are heated to about 100ºF – 105ºF (38ºC – 41ºC) before being injected.

Systemic chemotherapy may be recommended for all types of mesothelioma. Intraoperative chemotherapy, however, is more limited. Doctors may use intrapleural chemotherapy for pleural mesothelioma or intraperitoneal chemotherapy to treat peritoneal mesothelioma, but it is not used to treat pericardial mesothelioma.

Chemotherapy may be used as a singular treatment, though is often recommended in conjunction with surgery or radiation (multimodal therapy) to improve effectiveness and extend survival. The treatment can also be administered at different points in a patient’s treatment plan.

Chemotherapy Use in Multimodal Treatment
Neoadjuvant Chemotherapy

Drugs are administered before surgery in order to shrink the tumors, making them easier to remove.

Intraoperative Chemotherapy

Chemotherapy drugs are given during surgery to let doctors increase the dosage while minimizing side effects.

Adjuvant Chemotherapy

Drugs are administered after surgery to kill microscopic cancer cells left over and reduce risk of recurrence.

What to Expect During Chemotherapy Treatment

Preparing for chemotherapy will vary based on the type of drugs you are given and how they are being administered. Your doctor will provide you with specific instructions on how to best prepare, but there are some general things to keep in mind.

How to Prepare for Chemotherapy
Blood Work

To make sure your body is ready to handle chemotherapy, you’ll likely go through a series of blood tests to check kidney, liver, and heart function. Based on the test results, things like treatment time, drug type or dosage may be adjusted.

Go to the Dentist

Your doctor may direct you to see your dentist in order to rule out any existing infections, given that chemotherapy can lower your body’s ability to fight infection.

Organize Appointment Details

Some patients may be administered chemotherapy outside of their usual doctor office. It’s important to make detailed notes of when and where your treatment will be given. You should also arrange for a friend or loved one to come with you to the appointment, especially since you won’t know exactly how your body will respond.

Rest and Eat Light

It will probably be best if you eat a light meal beforehand, in case your treatment makes you nauseous. Also, make sure you get a good night’s sleep and rest leading up to your treatment.

Most patients will undergo several courses of chemotherapy treatment, usually administered once every three weeks or so. As treatment continues, your doctor and healthcare team will monitor dosage and side effects to see if the plan needs to be changed at all. Following the completion of chemotherapy, followup care will be just as important to address any ongoing or late-term side effects, as well as monitor how effective the treatment was and if further treatment is required.

Side Effects of Mesothelioma Chemotherapy

As each case of mesothelioma cancer is unique, so are the side effects patients may experience. Patients may face mesothelioma side effects from the progression of the cancer itself or as a result of treatments like chemotherapy. Though chemotherapy for mesothelioma is a common treatment and considered the standard of care for pleural mesothelioma, chemotherapy drugs typically are very toxic to the body and can have damaging side effects.

Common Chemotherapy Side Effects
  • Nausea
  • Vomiting
  • Hair loss
  • Low white blood cell count
  • Loss of appetite (anorexia)
  • Cachexia
  • Diarrhea
  • Fatigue
  • Dry mouth and mouth sores
  • Fever
  • Chills
  • Low platelet count
  • Tingling hands and feet
  • Rash
  • Sleep disorders
  • Depression
  • Sexual and reproductive issues

Some of these chemotherapy treatment side effects may be more severe than others, and not all of these symptoms can be cured. One of the most common side effects, chemo brain, is also among the most severe. Chemo brain refers to patients’ difficulties with memory and brain function after therapy, which can include forgetting even common words, having difficulty concentrating and multitasking, and taking longer to complete simple tasks. Chemo brain has no cure, but may be alleviated with some lifestyle changes like keeping a daily planner, sticking to completing one task at a time and working on mind exercises like crossword puzzles.

It’s important to talk to your doctor about any side effects that may arise throughout treatment and even after. Some common side effects of chemotherapy, like chemo brain and depression, may also be considered late-term or long-term side effects, meaning they may arise well after treatment has ended and affect the patient for months or even years. If left untreated, some of these side effects can lead to even more severe complications or impact the efficacy of the chemotherapy.

Managing Side Effects

Depending on an individual’s treatment plan and the side effects experienced, your doctor may be able to recommend a variety of supplementary treatments or lifestyle changes to alleviate the symptoms. Changes in diet, for instance, may help with side effects like nausea and vomiting, as well as muscle loss and fatigue.

Some treatment and mesothelioma side effects may require additional medications and therapies to resolve. Anorexia (loss of appetite) and cachexia (severe weight and muscle loss) may both be treated with medications like medroxyprogesterone (MPA) to promote weight gain, as well as non-steroidal inflammatory drugs to help prevent muscle loss. Sleep disorders caused by chemotherapy or other treatments may also require short-term sleep medication.

Whatever chemotherapy side effects you may be facing, it’s important to talk to your healthcare team about what you’re experiencing, and don’t try to treat the issue on your own.

Chemotherapy Drugs for Mesothelioma

Mesothelioma treatment typically employs a combination of two (or more) chemotherapy drugs. Currently, pemetrexed (Alimta) and cisplatin is the most common combination used to treat mesothelioma. For mesothelioma that cannot be operated on, bevacizumab (Avastin) is often administered at the same time as the other two drugs.

Most Common Mesothelioma Chemotherapy Drugs

Pemetrexed (Alimta)

The first and only chemotherapy drug to be approved by the FDA for treating patients with malignant pleural mesothelioma. Often used in conjunction with a platinum-based chemotherapy drug, such as cisplatin.

Cisplatin

A platinum-based chemotherapy drug typically used in combination with pemetrexed (Alimta). It has some of the most severe side effects of any chemo drugs, but also can be effective in killing mesothelioma cells.

Bevacizumab (Avastin)

An immunotherapy drug that prevents the creation of new blood vessels. Bevacizumab has been recommended by the National Comprehensive Cancer Network in combination with pemetrexed and cisplatin to treat inoperable cancers.

Other Chemotherapy Drugs

Other drugs may be used, depending on the type of mesothelioma and other factors. These include carboplatin, gemcitabine (Gemzar), doxorubicin (Adriamycin), paclitaxel (Taxol), onconase, navelbine, and cyclophosphamide.

Because each chemotherapy drug works a bit differently, your oncologist will advise on which is best suited to treating your disease. Your doctor will also provide guidance about the length and frequency of your chemotherapy treatments.

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.