Chemotherapy Drugs

Doctors use a variety of chemotherapy drugs individually and in multimodal approaches to treat mesothelioma patients.

Researchers have conducted a variety of clinical trials testing different combinations and single applications of chemotherapy drugs for mesothelioma. Below are some of the most commonly studied and used drugs in the treatment of mesothelioma. Clinical trials are ongoing for many to determine the most effective treatment combinations.

Dosage and frequency will vary based on an individual’s case and the doctor’s treatment plan. The course of treatment will also be influenced if these drugs are being implemented individually, as part of a multimodal treatment with either surgery or radiation, or if they are being used in tandem with another chemotherapy drug.

In general, these drugs are largely given intravenously or through an injection. Some, like cyclophosphamide, are also available in tablet form. Side effects may vary from person to person and may also depend on the drug or treatment combinations.

Alimta

Generic Name: Pemetrexed

Manufacturer: Eli Lilly and Co.

Commonly Used With: Cisplatin

Alimta is the first and only chemotherapy drug to be FDA approved to treat malignant pleural mesothelioma. When surgery is not an option, Alimta is considered one of the most important treatment options for mesothelioma patients. Most often, alimta is used in combination with cisplatin after a clinical trial showed together the drugs extended the patients’ survival to about 12 months, compared to 9 months when treated with cisplatin on its own. Another clinical trial conducted between 2008 and 2014, found a median survival of 16 months for 225 patients treated with a combination of alimta and cisplatin.

Avastin

Generic Name: Bevacizumab

Manufacturer: Genentech Inc.

Commonly Used With: Alimta + Cisplatin, Gemcitabine

Avastin has not been FDA approved to treat mesothelioma, but has been approved for the treatment of colorectal and lung cancers. In clinical trials, however, avastin in combination with other chemotherapy drugs has shown improvement in overall survival and quality of life among mesothelioma patients. In a clinical trial held from 2008 to 2014, 223 patients received a combination of avastin, alimta and cisplatin. This “triplet” therapy showed promising results, with patients’ experiencing a median survival of 19 months versus 16 months with the combination of just alimta and cisplatin. The triplet therapy, however, did have more adverse toxic side effects on patients than treatment without avastin, including hypertension and thrombotic events.

Carboplatin

Generic Name: Paraplatin

Manufacturer: Bristol-Myers Squibb

Commonly Used With: Gemcitabine, Alimta

Carboplatin is a chemotherapy drug that has been on the market since the 1980s, and has been popular for treating a variety of cancers, including lung and ovarian cancer. Unlike its parent compound, cisplatin, carboplatin has generally caused less severe side effects in patients. A clinical trial testing the combination of gemcitabine and carboplatin saw overall positive results among the 50 patients tested. On average, patients saw a 15 month survival and didn’t experience disease progression for about 9 months. Another more recent clinical trial testing carboplatin with alimta in the treatment of malignant pleural mesothelioma found a median survival of 12 months in 102 patients, with 6.5 months before disease progression. These patients also experienced a better quality of life, as this combination was lower toxicity.

Cisplatin

Generic Name: Platinol

Manufacturer: Bristol-Myers Squibb

Commonly Used With: Alimta, Gemcitabine

Cisplatin has been on the market since 1978, and has been used to treat many types of cancers such as ovarian, testicular, lung, and stomach cancers. Though not specifically FDA approved for the treatment of mesothelioma, it is often recommended by mesothelioma doctors when curative surgery is not an option, usually in the combination with Alimta or other chemotherapy drugs. Cisplatin with alimta as a first-line chemotherapy treatment has been the standard of care for many years. Because of its development decades ago, however, cisplatin is known for having potentially more severe side effects than other similar drugs.

Cyclophosphamide

Generic Name: Cytoxan, Cytophosphane, Neosar

Manufacturer: West Ward Pharmaceuticals

Commonly Used With: Pentostatin, Doxorubicin

Cyclophosphamide is mainly used in the clinical trial stage to see if it’s a viable combination chemotherapy for mesothelioma. In an ongoing clinical trial, cyclophosphamide is being used in combination with pentostatin, another chemotherapy drug that has been used to treat mainly hairy cell leukemia, and SS1P, an immunotherapy drug. This phase II trial is studying if the two chemotherapy drugs will make the SS1P more effective, and is suspected to conclude later this year. Other clinical trials with cyclophosphamide have tested its effectiveness with doxorubicin, which have seen mixed results so far. For instance, one 2010 study investigating these two drugs in combination with platinum-based chemotherapy found the median for progression-free survival was a mere 1.5 months, which is much lower than the median when using the standard of care. Researchers hope with further study they will find the right combination for cyclophosphamide to be most effective.

Doxorubicin

Generic Name: Adriamycin, Doxil

Manufacturer: Janssen Products

Commonly Used With: Cisplatin, Paclitaxel

Doxorubicin has shown many potential benefits for overall survival and tumor reduction for mesothelioma patients. It has been widely studied for mesothelioma, though is currently only FDA approved for the treatment of breast, lung and liver cancers, as well as leukemia. In a phase II clinical trial testing doxorubicin with cisplatin, researchers found a median overall survival of 19.6 months and nearly 5 months before the disease showed progression in patients with stage 3 or stage 4 mesothelioma. Another clinical trial suggested doxorubicin could be a means of long-term survival in patients after examining the case of 67-year-old patient who worked in the asbestos industry and developed mesothelioma. Doxorubicin combined with paclitaxel and etoposide resulted in a 9 year survival for the patient, at the time the study was released.

Gemcitabine

Generic Name: Gemzar

Manufacturer: Eli Lilly and Company

Commonly Used With: Cisplatin, Carboplatin, Alimta

Gemcitabine is a newer chemotherapy drug, which has been approved to treat several types of cancers including non-small cell lung cancer, pancreatic cancer and breast cancer. It has often been used in combination with cisplatin or carboplatin as a first-line or second-line of treatment. Some studies have shown this treatment to have little positive impact on overall survival, though researchers concluded it is still a viable option because it provided a high stability rate (46% of 60 patients in the trial saw stable disease). Another study compared the standard of care (alimta and cisplatin) against cisplatin or carboplatin with gemcitabine, and found the median survival was 11 months for either treatment in stage 4 mesothelioma patients.

Navelbine

Generic Name: Vinorelbine tartrate

Manufacturer: Pierre Fabre Pharmaceuticals

Commonly Used With: Cisplatin

Navelbine is another relatively new chemotherapy drug and has been commonly used in treating breast cancer, ovarian cancer and Hodgkin’s lymphoma. For mesothelioma patients, navelbine has shown promise as both a first-line and second-line treatment, as well as among relapsed patients. One study navelbine provide a nearly 10 month overall survival for malignant mesothelioma patients who had relapsed. A study of navelbine and cisplatin as a first-line treatment also saw promising results, as patients with inoperable mesothelioma saw a median survival of nearly 17 months.

Onconase

Generic Name: Ranpirnase

Manufacturer: Alfacell Corporation

Commonly Used With: Doxorubicin

Onconase is a new experimental chemotherapy drug that has shown potential for a number of cancers including mesothelioma. It’s currently in an ongoing clinical trial studying its impact in combination with doxorubicin. The most recent available results showed the combination extended median survival to 12 months compared to 10 months with just doxorubicin, with 47% patients still having survived at the year mark. Other studies have suggested that onconase could be a valuable addition to treatment with other chemotherapy drugs, as it has been shown to help stabilize cancer cells and prevent tumor growth.

Paclitaxel

Generic Name: Taxol, Onxal

Manufacturer: Bristol-Myers Squibb

Commonly Used With: Cisplatin, Carboplatin

Paclitaxel has shown success in treating a number of cancers, such as breast cancer, ovarian cancer and lung cancer. Unfortunately, it has seen rather mixed results with its impact on mesothelioma. A phase II study found the chemotherapy drug found an average median survival of just about 9 months with a 30% one-year survival rate, which wasn’t nearly as successful as the other chemotherapy drugs commonly used in treatment. More current studies are evaluating paclitaxel’s effectiveness in combination with cisplatin and carboplatin, which will hopefully show a more promising outcome.

Side Effects of Chemotherapy Drugs

Different chemotherapy drugs can have a variety of side effects, some more severe than others. Through the clinical trials mentioned above, researchers have also witnessed a range of side effects from different combinations or singular drugs, from nausea to elevated blood pressure and hemorrhaging.

Your doctor will be able to explain any expected side effects and will monitor your reactions to your treatment throughout. Between visits, you should keep track of any symptoms you’re experiencing, which will help your doctor recommend ways to better manage side effects, whether it’s tweaks to the treatment plan or lifestyle changes.

Most Common Side Effects

  • Nausea and vomiting
  • Loss of appetite
  • Fatigue
  • Hair thinning or loss
  • Increased risk of infection
  • Decreased white blood cell count
  • Mouth sores and dry mouth
  • Skin rash

Paying for Chemotherapy

Cancer treatment is expensive, with costs rising higher each year. Chemotherapy in general is estimated to cost as much as $50,000 per course of treatment. Considering patients often go through multiple courses, these expenses can add up quickly.

Having a good insurance plan can help cover some of the costs of chemotherapy and treatment, and it’s just as important to understand what your plan will and will not cover and know what to expect for out-of-pocket payments. For instance, if you have a plan based on copayments, you may have a fixed payment each time you receive chemotherapy. If you have a deductible plan, you will pay out of pocket for treatment until you have reached the set deductible amount. Fortunately, plans generally have a cap that sets the maximum amount of out-of-pocket payments for your medical care.

Patients may also ask their doctors if there’s an alternative for an expensive treatment. With chemotherapy drugs, there may be a generic brand that has the same effects as a name brand drug at less cost.

Even limited out-of-pocket costs can still be too expensive for many households on top of regular household bills and secondary costs that come with cancer treatment. If you’re looking for other ways to help offset the cost of treatment, you may find more resources on our financial planning page, which provides some assistance options for treatment, lodging, and travel expenses.

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Sources & About the Writer [+]
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  • 5 National Cancer Institute. FDA Approval for Pemetrexed Disodium.
  • 6 Porta Camillo, Paglino Chiara. Ranpirnase and its potential for the treatment of unresectable malignant mesothelioma. 2008; 601-609.
  • 7 Ruling Shen, Jun Li et al. Combination of onconase and dihydroartemisinin synergistically suppresses growth and angiogenesis of non–small-cell lung carcinoma and malignant mesothelioma. ABBS. 2016; 894-901.
  • 8 Steele Jeremy, Shamash Jonathan et al. Phase II Study of Vinorelbine in Patients With Malignant Pleural Mesothelioma. Journal of Clinical Oncology. 2000;3912-3917.
  • 9 Yan TD, Welch L, Black D, and PH Sugarbaker. A systematic review on the efficacy of Cytoreduction surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann Oncol. 2007; 18 (5): 827-834.
  • 10 Zalcman G, Mazieres J, Margery J et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomized, controlled, open-lab, phase 3 trial. Lancet. 2015 S0140-673 (15): 01238-6.
  • 11 Zauderer Marjorie, Kass Samantha et al. Vinorelbine and Gemcitabine as Second- or Third-Line Therapy for Malignant Pleural Mesothelioma. Lung Cancer. 2014;271-274.
  • 12 Zarogoulidis P, Mavroudi M, Parpodis K et al. Pegylated liposomal doxorubicin in malignant pleural mesothelioma: a possible guardian for long-term survival. Onco Targets Ther. 2012; 5:231-236.
  • About The Writer Photo of Dan Heil Dan Heil

    Dan is a contributing writer for The Mesothelioma + Asbestos Awareness Center. He hopes to help educate on everything related to a mesothelioma diagnosis and answer any questions patients or family members may have.