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 about Chemotherapy
- Chemotherapy is the standard treatment for most cases of pleural and peritoneal mesothelioma.
- The most common chemotherapy combination for mesothelioma is pemetrexed (Alimta) and cisplatin, though other drugs may be used.
- Chemotherapy can have a number of side effects, the most frequent of which include nausea, vomiting, fatigue, and loss of hair.
While chemotherapy cannot cure mesothelioma and is associated with a number of unpleasant side effects, it can alleviate nonetheless kill cancer cells, thereby reducing the symptoms of mesothelioma, improving quality of life, and potentially extending life expectancy.
Chemotherapy is the standard treatment for most cases of mesothelioma, often used in conjunction with surgery and/or radiation.
Success Rate of Chemotherapy for Mesothelioma
Nearly 20 percent of mesothelioma patients who are treated with chemotherapy only live 2 years, while only 4 percent live at least 5 years. However, patients who combined chemotherapy with other forms of treatment have a much better survival rate.
How Chemotherapy Treats Mesothelioma
There are two primary goals when using chemotherapy to treat mesothelioma: to kill cancer cells, and to reduce symptoms.
Killing Cancer Cells: 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.
Reducing Symptoms: Chemotherapy can 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.
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 mesothelioma patients.
More recently, doctors have discovered that administering multiple chemotherapy drugs together is more effective than providing single doses. A mesothelioma patient’s specific treatment plan will depend on their diagnosis.
What to Expect During Chemotherapy Treatment
Chemotherapy drugs may be administered in two ways:
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.
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.
- Intrapleural Chemotherapy: Used after pleural mesothelioma operations to kill cancer cells in the chest cavity.
- Intraperitoneal Chemotherapy: Used after peritoneal mesothelioma surgery.
Intraoperative chemotherapy is not used to treat pericardial mesothelioma.
Chemotherapy Treatment Options
Chemotherapy is often used in conjunction with radiation and/or surgery to improve effectiveness and, hopefully, the patient’s chance of survival. This is known as multimodal therapy.
Chemotherapy can be administered at different points in a patient’s treatment plan.
Drugs are administered before surgery in order to shrink the tumors, making them easier to remove.
Chemotherapy drugs are given during surgery to let doctors increase the dosage while minimizing side effects.
Drugs are administered after surgery to kill microscopic cancer cells left over and reduce risk of recurrence.
Side Effects of Chemotherapy
Many patients are concerned about the side effects of chemotherapy. Different drugs have different side effects – for example, although many people associate hair loss as a side effect of chemotherapy, not all chemotherapy drugs cause the loss of hair.
Another side effect of chemotherapy is what has come to be known as “chemo brain.” Patients may have difficulty concentrating, thinking, or remembering names, dates, and events. It may also take more time to finish projects or remembering common words.
Your doctor will be able to tell you what side effects are possible based on your specific treatment plan.
- Hair loss
- Low white blood cell count
- Loss of appetite
- Dry mouth and mouth sores
- Low platelet count
- Tingling hands and feet
- Sexual and reproductive issues
Tell your doctor about any side effects you experience, even if they are expected. Even “common” side effects could be dangerous or lead to complications if left untreated.
Managing Side Effects
As patients experience different side effects, it’s important to speak with a healthcare team about how to effectively manage them. Depending on which side effects you experience, your doctor may recommend specific dietary, lifestyle, or treatment changes you can make to lessen their severity.
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.