Chemotherapy for Mesothelioma

Chemotherapy is an aggressive mesothelioma treatment effective in reducing tumors and killing cancer cells of pleural and peritoneal mesothelioma with powerful drugs, but it's accompanied by side effects including hair loss, vomiting and fever.

Patient Advocate Karen Selby explains chemotherapy to mesothelioma patients.

Chemotherapy can be a frightening treatment to consider, but this therapy is recognized as one of the few treatment options that can be effective for mesothelioma patients. Chemotherapy cannot cure mesothelioma, but depending on the severity of the cancer, it can alleviate symptoms, improve quality of life and prolong survival. For patients who are not candidates for surgery and are diagnosed with stage III or IV mesothelioma, a major treatment decision is often whether or not to undergo chemotherapy.

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The primary objective of this treatment is to kill cancer cells and shrink tumors. It attacks cells that are rapidly dividing and interrupts the division process. While chemotherapy is meant to target cancer cells, it can harm any cells throughout the body that divide quickly. For example, hair follicles are among the fastest growing cells and therefore are easily damaged during treatment, leading many cancer patients to experience temporary hair loss.

Chemotherapy relieves symptoms of mesothelioma by effectively reducing tumor size, and may lessen the risk of spread (metastasis) or extend life expectancy. Treatment plans can vary depending upon the type of mesothelioma you are diagnosed with, as pleural and peritoneal mesothelioma patients may receive different drugs and methods of administration.

Therapy Options

The length and type of treatment a patient receives is determined by factors like the type of cancer, stage and extent of the cancer, patient health and type of drug administered. Mesothelioma patients receive chemotherapy either systemically or directly into the body cavity where the cancer is located.

Methods of Administering Chemotherapy

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Systemic

Medication is either injected into a vein or swallowed in pill form. The medication enters the bloodstream and systemically circulates throughout the body.

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Intrapleural or Intraperitoneal

The drug is administered through a small tube straight into the body cavity where the cancer is developing. Medication still enters the bloodstream, but the greatest concentration is absorbed in the area where cancer cells reside.

Chemotherapeutic drugs are given in cycles. The duration, frequency and total number of cycles will vary from patient to patient. Treatment plans can be implemented in the following ways:

Mesothelioma Chemotherapy Treatment Plan Options

  • Chemotherapy alone
    This is the only treatment the patient undergoes.

  • Multimodal therapy
    In this approach, chemo is combined with one or more other treatments, such as surgery and radiation therapy.

  • Neoadjuvant
    Before a patient undergoes surgery, chemotherapy is used to reduce tumor size.

  • Adjuvant
    A method that applies chemotherapy after surgery to reduce the risk of recurrence.

  • Palliative
    This treatment aims to relieve symptoms of mesothelioma and may be paired with another treatment such as radiation therapy.

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Chemotherapy Drugs for Mesothelioma

These drugs are usually given in combinations of two or more, but one drug can be administered in patients who are not healthy enough to handle a combination. The most common combination for pleural mesothelioma treatment is Alimta (pemetrexed) paired with cisplatin.

Most Common Mesothelioma Chemotherapy Drugs

Other drugs applied in the treatment of mesothelioma may include methotrexate, vincristine, vinblastine, mitomycin, doxorubicin, epirubicin, cyclophosphamide and ifosfamide.

Single Agent and Combination

Single Agent

Single agent chemotherapy uses one anticancer medication. Over the course of many clinical trials, mesothelioma patient response rates to single agents have typically been very low, ranging from 0 percent to 15 percent in most studies. In unique cases, sometimes involving high doses of a medication, response rates have increased. Chemotherapy medications that have been used as single agents for mesothelioma include cisplatin, carboplatin and doxorubicin.

Combination

Combination therapy involves the use of two or more anticancer medications. Recent studies showed positive results in mesothelioma patients undergoing this type of chemo. The combination of cisplatin and pemetrexed can be an effective option.

Surgery and Perioperative Intraperitoneal Chemotherapy

Values: represent months

Surgery and Perioperative Intraperitoneal Chemotherapy

Study spotlight In a 2003 Phase III clinical trial testing the combination of pemetrexed and cisplatin versus the single use of cisplatin, 448 mesothelioma patients received chemotherapy. A total of 226 patients received pemetrexed and cisplatin while 222 received cisplatin alone. Results demonstrated that the combination of pemetrexed and cisplatin was more effective in terms of survival (12.1 months vs. 9.3 months), median time to progressive disease (5.7 months vs. 3.9 months) and response rate (41 percent vs. 17 percent).

Other combinations previously applied in the treatment of mesothelioma include cisplatin and doxorubicin, cisplatin and mitomycin, and cisplatin with gemcitabine. Three-drug combinations have not demonstrated better results than two-drug combinations.

Combination Chemotherapy Clinical Trials

Clinical trials on combination chemotherapy revealed beneficial results for mesothelioma patients. Many of these studies reported a survival advantage with the combination of cisplatin and other chemotherapy drugs. More importantly, clinical trials testing the effects and response rates of chemotherapy are gradually increasing the knowledge of specialists that study mesothelioma treatment.

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First Line and Second Line

First line chemotherapy offers the most favorable approach to treating cancer. First line chemotherapy for pleural mesothelioma patients is typically a combination of cisplatin and pemetrexed, although other medications may be used depending on a number of factors. If first line chemotherapy fails to treat the cancer or demonstrate positive results, second line chemotherapy may be prescribed. A second round of chemotherapy may involve a similar approach to the initial treatment or a completely different combination of medications.

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Side Effects

Although chemo is often used in conjunction with other treatments such as surgery and radiation therapy, it can act as a first line treatment option for mesothelioma patients who are not candidates for surgery. Before considering chemotherapy as a treatment option for mesothelioma, it is important for patients to become familiar with the side effects:

Side Effects:

  • Hair loss
  • Nausea and vomiting
  • Lower platelet count
  • Compromised immune system
  • Body aches
  • Tingling in the feet and hands
  • Anemia (decrease of red blood cells)
  • Loss of appetite
  • Constipation or diarrhea
  • Rash
  • Fatigue
  • Fever

Treatment for Peritoneal Mesothelioma

Chemotherapy for peritoneal mesothelioma patients differs from the type of chemotherapy given to pleural mesothelioma patients. Known as “intraperitoneal chemotherapy,” the method inserts a high drug concentration directly into the peritoneal cavity, but penetration into tumors is generally poor..

Studies of intraperitoneal drug delivery have shown that direct tumor absorption occurs at a level of only a few millimeters from the surface. As a result, hyperthermic intraperitoneal chemotherapy (HIPEC), also known as heated chemotherapy, may be an option for peritoneal mesothelioma patients. The high temperature of the solution increases the effectiveness of the medication to hopefully prolong survival and reduce pain.

Surgery and Perioperative Intraperitoneal Chemotherapy

Survival Rate of Patients Who Undergo Surgery and Perioperative Intraperitoneal Chemotherapy

Study Spotlight: Survival rate of patients who were healthy enough to undergo surgery and perioperative (meaning before or after surgery) intraperitoneal chemotherapy.

Additional Resources


Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining Asbestos.com in 2009.

  1. http://www.cancer.org/Cancer/MalignantMesothelioma/DetailedGuide/malignant-mesothelioma-treating-chemotherapy
  2. Edt. By Baldi, A. (2008). The Radiology of Mesothelioma. Mesothelioma from Bench Side to Clinic. New York: Nova Science Publishers, Inc.
  3. Robinson, B., Chahinian, P. (2002). Mesothelioma. Martin Dunitz: London.
  4. O’Byrne, K. and Rusch, V. (2006). Malignant Pleural Mesothelioma. New York: Oxford University Press.
  5. Pass, H., Vogelzang, N., Carbone, M. (2005). Malignant Mesothelioma. New York: Springer Science Business Media Inc.
  6. Yan, T., Sugarbaker, P. (2008). Cytoreductive Surgery Combined with Perioperative Intraperitoneal Chemotherapy for Diffuse Malignant Peritoneal Mesothelioma - Prognostic Features of Long-Term Survivors. Edt. By Baldi, A. Mesothelioma from Bench Side to Clinic. New York: Nova Science Publishers, Inc.

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