Mesothelioma Chemotherapy

Mesothelioma Chemotherapy Treatment Goals

The main goal of chemotherapy for mesothelioma is to target and kill off mesothelioma cells so they cannot spread throughout the body. Stopping cancer cell growth also helps shrink tumors and reduce painful symptoms associated with tumor growth.

Mesothelioma chemotherapy drugs can be used as first- or second-line treatment. That means they can either serve as a patient’s primary treatment or play a supportive role with other mesothelioma treatments like surgery, immunotherapy, and palliative care.

Chemotherapy Treatment for Mesothelioma

During chemotherapy, patients receive powerful drugs that destroy cancer cells. Depending on the type of chemotherapy, these drugs may be given intravenously (through a vein), in pill form, or directly into the abdominal or chest cavities during surgery.

Mesothelioma chemotherapy (chemo) may be administered in two main ways:

• Intraoperative chemotherapy: Mesothelioma doctors execute this treatment after performing surgery while the incision site is still open. The heated anti-cancer drug is released directly into the chest or abdominal cavity after the surgeon has removed all visible cancer. The chemotherapy kills any remaining microscopic cancer cells the surgeon can’t see.
• Systemic chemotherapy: In this procedure, chemotherapy drugs are most commonly given to the patient through a port or needle into a vein. The drug then enters the bloodstream, destroying cancer cells wherever they are in the body.

There are several different kinds of chemotherapy drugs for mesothelioma, including cisplatin, pemetrexed, and gemcitabine.

While some people do not respond well to these drugs, many mesothelioma patients have beaten the odds and lived longer with the help of mesothelioma treatment chemotherapy.

Benefits of Chemotherapy for Mesothelioma

Chemotherapy may be offered to patients as a treatment option at any of the four stages of mesothelioma. However, specific mesothelioma treatment goals vary depending on the patient’s condition.

Doctors use chemotherapy for mesothelioma to:

1. Kill remaining cancer cells left over after surgery
2. Prevent recurrence (when the mesothelioma comes back) by administering chemotherapy directly into the body
3. Reduce painful symptoms by destroying cancer cells, which may shrink tumors
4. Shrink tumors and eliminate mesothelioma cells before surgery to help improve surgical success

Mesothelioma specialists continue studying different chemotherapy techniques to get the best results for patients seeking curative (life-extending) and palliative (symptom-relieving) treatments.

If you are receiving treatment for mesothelioma or getting ready to start your treatment journey, our list of 14 Questions to Ask Your Doctor can help you get the information you need about clinical trials, second opinions, and more.

Survival Rates With Chemotherapy Alone

Because mesothelioma is often not discovered until it has already spread (stage 3 or stage 4 mesothelioma), only 20% of patients are candidates for curative surgery.

The standard treatment for the remaining 80% of mesothelioma patients is chemotherapy, with a median survival rate of 12 months.

Patients whose mesothelioma is caught in the earlier stages and can undergo surgery often receive a multimodal (more than one therapy) approach to treatment.

This involves a combination of surgery, radiation, and chemotherapy. The median survival rate for these mesothelioma patients is 12-29 months, depending on which surgical procedure they receive.

For patients with late-stage mesothelioma that cannot be removed through surgery, chemotherapy may also help slow cancer growth and ease symptoms.

“Open and frank communication between physician and patient about when to cease chemotherapy was recommended, as it was found that patients who received chemotherapy at the end of life had shorter survival compared to those who did not.”
—Study published in Journal of Palliative Medicine, June 2021

Chemotherapy Drug Types for Mesothelioma

Mesothelioma chemotherapy drugs are highly concentrated, anti-cancer medications. When these drugs are injected into the bloodstream, they circulate throughout the body and destroy mesothelioma cells in their path. This slows the rate of cancer growth.

Mesothelioma researchers have found that combining two drugs is more effective than using a single drug.

Here are the mesothelioma chemotherapy drugs that are commonly used to treat patients.

Cisplatin and Pemetrexed

The combination of cisplatin and pemetrexed (Alimta®) has been the standard therapy for mesothelioma patients for over 10 years.

These are typically the first drugs that mesothelioma patients receive. When patients cannot tolerate cisplatin, it can be replaced with carboplatin — another platinum-based chemotherapy drug.

Cisplatin and pemetrexed can significantly improve mesothelioma survival rates. Mesothelioma patients typically continue receiving this combination of drugs until they stop responding to them or develop too many side effects.

Gemcitabine

Gemcitabine (Gemzar®) is a chemotherapy drug initially developed for breast and lung cancers. However, it has effectively improved life expectancy in late-stage mesothelioma patients.

When the first-line chemotherapy solution of cisplatin and pemetrexed stops working, gemcitabine can be prescribed as a second-line treatment.

Other Mesothelioma Chemotherapy Drugs

There are several other chemotherapy medications for mesothelioma that doctors can prescribe.

Other mesothelioma chemotherapy drugs may include:

• Doxorubicin (Adriamycin®)
• Navelbine (vinorelbine)
• Onconase (ranpirnase)

Onconase is being tested in clinical trials.

Patients can learn more about affording chemotherapy and other mesothelioma treatment options by speaking with a medical social worker or a legal professional.

Mesothelioma Hope’s caring and knowledgeable Patient Advocates can help by providing information on top mesothelioma doctors and financial assistance for treatment.

Side Effects of Chemotherapy

Mesothelioma chemotherapy drugs are effective against cancer because they attack fast-growing cells. However, these drugs also target healthy cells. Many chemotherapy side effects result from the death of these cells.

Some of the most common chemotherapy side effects include:

• Constipation and diarrhea
• Fatigue
• Hair loss
• Loss of appetite
• Low blood cell counts (both red blood cells and white blood cells)
• Mouth sores
• Nausea
• Weakened immune system
• Weight changes

Mesothelioma chemotherapy drugs affect patients differently. Some patients experience severe side effects and need to stop or change drugs.

If this happens, a mesothelioma patient’s health care team will do everything possible to keep them comfortable.

However, some vitamins can make mesothelioma chemotherapy less effective. Patients undergoing mesothelioma chemotherapy therapy should talk to their cancer care team about any vitamins or supplements they take.

Multimodal Treatment and Chemotherapy

A multimodal treatment plan involves using more than one form of mesothelioma treatment (generally surgery, chemotherapy, and/or radiation) in order to increase a patient’s chances of long-term survival.

The best chemotherapy results are seen when chemotherapy is combined with surgery. Some patients have experienced long periods of remission following this treatment.

Multimodal Survival Rates

In some patients, a multimodal treatment approach involving chemotherapy, surgery, and radiation therapy has increased survival to over 5 years.

Mesothelioma doctors may use chemotherapy in different ways to achieve the best results for multimodal therapy.

As part of a multimodal treatment plan, chemotherapy may be used in several ways:

• Adjuvant therapy: Chemotherapy may also be used after surgery to prevent cancer from growing back.
• Intraoperative chemotherapy: Chemotherapy drugs are delivered directly to the tumor’s location after doctors surgically remove as much cancer as possible.
• Neoadjuvant therapy: Chemotherapy may be used before surgery to shrink the cancer and make it operable and easier to remove or to prevent cancer from spreading during the operation.

Combining chemotherapy and radiation therapy may also be useful for controlling cancer symptoms when surgery is not a realistic option.

New Chemotherapy Treatments

Mesothelioma specialists conduct ongoing research to develop new chemotherapy drugs that extend the lives and well-being of those afflicted with this deadly disease.

Targeted Chemotherapy for Mesothelioma

The medical community uses targeted chemotherapy for many types of cancer. This treatment is receiving attention from top mesothelioma doctors.

Targeted chemotherapy is a newer kind of “smart” therapy that targets changes in cells that are unique to cancer. In this way, targeted therapy is able to destroy cancer cells without affecting healthy cells and producing symptoms.

Researchers have discovered gene and protein changes when mesothelioma presents itself in a person. Targeted chemo drugs work by directly addressing those changes caused by the disease.

A protein called VEGF (vascular endothelial growth factor) aids cancerous tumors by forming new blood vessels so the tumors can access the nutrients they need to continue growing.

A newer drug called Bevacizumab (Avastin®) stops VEGF from working and helps starve the tumor. When given alongside the chemotherapy drugs pemetrexed and cisplatin, it has been shown to help people with mesothelioma live longer.

Mesothelioma Chemotherapy Clinical Trials

Specialists often recommend that their patients join mesothelioma clinical trials where new drugs and treatments are constantly being developed and tested.

Doctors hope to improve the quality and lifespan of mesothelioma patients through these clinical trials.

A search of the clinical trial database clinicaltrials.gov in December 2022 revealed more than 50 active clinical trials for mesothelioma involving chemotherapy.

For example, one clinical trial examines whether adding a type of immunotherapy called durvalumab to chemotherapy will help patients with advanced pleural mesothelioma.

Other researchers are testing whether a cancer medication called nivolumab combined with chemotherapy in pleural mesothelioma patients after surgery is beneficial.

Not sure which mesothelioma treatment is right for you? We can connect you with top mesothelioma specialists in your area who can help.

Chemotherapy by Mesothelioma Type

Pleural mesothelioma is the most common form of the disease. It is caused by asbestos exposure that affects the lining of the pleural cavity where the lungs rest.

Chemotherapy for Pleural Mesothelioma

Chemotherapy is commonly used to treat pleural mesothelioma alone or in combination with surgery and/or radiation therapy. Pleural mesothelioma chemotherapy may be palliative or curative.

Since 2004, doctors have used a combination of the drugs pemetrexed and cisplatin to treat malignant pleural mesothelioma. This drug combination helps cancer patients by slowing the progression of the disease and improving quality of life.

Pleural mesothelioma chemotherapy takes two main forms:

• Intraoperative chemotherapy: For surgical patients who receive either an extrapleural pneumonectomy (removal of the diseased lung and surrounding tissue and tumors) or pleural decortication (removal of the diseased lining of the lung), the more localized form of chemotherapy called HITHOC (heated chemotherapy) has been proven to increase the length of survival. Some doctors also recommend this procedure for patients undergoing pleurectomy and decortication (P/D).
• Systemic chemotherapy: Research shows that chemotherapy that travels throughout the body reduces tumors in 40% of patients, thereby extending the patient’s life. Because chemotherapy can shrink tumors, it may help patients struggling to breathe and have fluid buildup in their lungs.

HITHOC (hypothermic intrathoracic chemotherapy) is a procedure where heated chemotherapy drugs are applied directly into the pleural cavity after the surgeon removes all visible cancerous tumors and tissue.

The drug kills the remaining microscopic cancer cells, and the heat allows the drug to permeate the tissue better and magnifies the effects. Cisplatin is often used in HITHOC, but doxorubicin and mitomycin C can also be used.

Chemotherapy for Peritoneal Mesothelioma

Specialists also use a combination of pemetrexed and cisplatin to treat patients with peritoneal mesothelioma.

Types of peritoneal mesothelioma chemotherapy include:

• Systemic chemotherapy: This is usually the first-line treatment for patients diagnosed in the later stages of mesothelioma. Carboplatin can be successfully substituted for cisplatin and seems better tolerated by patients.
• Intraoperative chemotherapy: For surgical candidates whose mesothelioma has been diagnosed in the earlier stages, cytoreductive surgery with HIPEC (hyperthermic intraperitoneal chemotherapy) offers promise to extend life.

Like HITHOC, HIPEC is administered locally in the abdominal cavity immediately after surgically removing visible cancerous tumors and tissue. This heated chemotherapy kills cancer cells left behind that are invisible to the naked eye.

Survival rates for malignant peritoneal mesothelioma patients who are surgical candidates can range from 38-92 months after the surgical/chemotherapy treatment combination.

What to Expect During Mesothelioma Chemotherapy

If your doctor has recommended chemotherapy for your mesothelioma, consult a specialist before beginning treatment.

Your mesothelioma doctor will work with you to develop a treatment plan and explain what you can expect during chemotherapy for mesothelioma.

Systemic Chemotherapy Process for Mesothelioma

A mesothelioma chemotherapy regimen involves a series of treatment cycles over a set period. Patients may receive a single or combination of drugs during each treatment.

Specialists develop personalized mesothelioma chemotherapy treatment plans for each patient based on their medical needs and goals.

Your treatment regimen will outline chemotherapy drugs, dosages, and administration methods.

Chemotherapy for mesothelioma generally involves the following steps:

• Chemotherapy is often given as an infusion into a vein through a needle inserted into the skin. The drugs can also be given by inserting a tube into a device in a vein in your chest.
• Doctors administer mesothelioma chemotherapy in 3-4 week cycles, each with a rest period in between. This gives healthy cells time to recover between the treatments.
• A single chemotherapy session might last anywhere from a few minutes to hours, depending on the specific treatment prescribed by your doctor.

Most patients receive 4-6 cycles of chemotherapy treatment, depending on the state of the disease and the response to the drugs. Effectiveness should be reassessed every 2-3 cycles.

If mesothelioma chemotherapy is proving effective, the treatment might continue longer.

How to Prepare for Chemotherapy

Chemotherapy involves introducing powerful drugs into your body so they can effectively kill deadly cancer cells.

Because the drugs are so strong, patients are encouraged to prepare their bodies in order to receive the most benefit from the treatment. A doctor will determine how mesothelioma chemotherapy should be administered.

To prepare for mesothelioma chemotherapy, patients may need to do the following.

1. Get a Chemotherapy Access Point: Patients receiving intravenous chemotherapy may have a port, catheter, or pump surgically implanted to deliver the chemotherapy agent.
2. Complete Preliminary Testing: Patients take blood tests to ensure they are strong enough to receive chemotherapy drugs. Tests might be conducted on the blood, liver, kidneys, and heart to ensure they function properly.
3. Visit the Dentist: Patients may need to see a dentist to make sure there are no infections in the mouth. It is more difficult for the body to fight off infection during chemotherapy.
4. Plan for Side Effects: Patients concerned about fertility issues should preserve eggs or sperm for future use. They may wish to purchase a wig or head covering for hair loss and ask their doctor about anti-nausea and vomiting drugs.
5. Arrange Extra Help: People undergoing chemotherapy often continue to work and perform activities. Patients should ask their doctor what to expect. Ask if you will need to arrange for extra help at home in case your side effects prevent you from carrying out normal activities.
6. Prepare for the First Treatment: Patients should prepare for their first treatment by arriving well-rested. They may wish to eat a light meal beforehand if the chemotherapy makes them nauseous. While most people drive themselves back and forth to treatment, the first time, someone else should drive until the patient and their doctor see how they react to the drugs.

The best way to prepare for chemotherapy varies among individuals. Patients should always follow their doctor’s medical advice.

Learn More About Chemotherapy for Mesothelioma

For more information about receiving mesothelioma chemotherapy or contacting a specialist for a consultation, Mesothelioma Hope is here to help.

Contact our Patient Advocates today for answers to any questions about chemotherapy for mesothelioma and how it works with your treatment plan.