What Is Chemotherapy for Malignant Mesothelioma?

Chemotherapy is a group of chemicals that can kill cancer cells and stop them from growing back. These drugs can also hurt the healthy cells in your body. They are often a first-line treatment for mesothelioma. When prescribing chemo, doctors will consider your tumor location, cell type and general health.

Doctors may give chemo by itself or use it with surgery or radiation therapy

“In Europe they still like to do the chemotherapy first,” Dr. Charles Simone, a radiation oncologist at the University of Maryland Comprehensive Cancer Center, told The Mesothelioma Center at Asbestos.com. “Here in the United States there is more of the mentality that if you think surgery is the best way to achieve long-term survival, why delay it? Fewer centers now are doing chemotherapy first in this country.”

The most common mesothelioma chemotherapy drugs are cisplatin and pemetrexed. Alimta is the brand name for pemetrexed. The specific drug or combination of drugs a person gets depends on their diagnosis. Doctors sometimes try different medications or targeted therapies to see what works best.

Chemotherapy isn’t for everyone. It has side effects that may be too much for older patients or those with specific health issues. Advanced mesothelioma patients may not benefit as much. Others may not be eligible due to medical conditions. Talk to your medical team to find the best treatment option for you.

Chemotherapy Drugs Used for Mesothelioma

Mesothelioma doctors use chemotherapies in different ways. The standard chemotherapy drugs for mesothelioma are cisplatin and Alimta. Each drug has its pros and cons. 


After diagnosis, doctors give mesothelioma chemotherapy drugs made for initial treatment. These medicines work well for people who haven’t had cancer treatment before. If cancer returns, doctors prefer using different therapies for further treatments.

Clinical trials for mesothelioma show that a combination of cisplatin and Alimta is often the best chemotherapy for first-line mesothelioma. This might not be the best option for everyone, but several other drugs are available.

Common mesothelioma chemotherapy drugs include:
  • Carboplatin
  • Cisplatin
  • Cyclophosphamide
  • Doxorubicin
  • Gemcitabine (Gemzar)
  • Pemetrexed (Alimta)
  • Raltitrexed
  • Vinorelbine

Drug combinations may also be effective during heated chemotherapy used in surgery. Common choices are cisplatin, doxorubicin and mitomycin C. Thoracic surgeon Dr. Jeffrey Velotta told The Mesothelioma Center that there may be more risk for pleural patients. 

“There is some controversy. Does it improve survival? That’s never really been shown,” Velotta said.

Cancer may come back after you finish the first round of treatment. If this happens, your doctor may suggest other drugs for the second round of chemotherapy. Ask your mesothelioma specialist what your options are if the cancer returns. They will consider your allergies, type of cancer cells and medical history. 

Side Effects of Chemotherapy for Mesothelioma

While chemotherapy is the most effective treatment for malignant mesothelioma, side effects are common. Some can be severe. Monitor your health closely during chemo for adverse reactions. 

Common side effects include:
  • Chemo Brain: Many chemo patients experience varying degrees of memory loss or confusion. Chemo brain can be short-lived or last for years.
  • Diarrhea and Constipation: Chemo drugs often irritate the gastrointestinal tract lining. Peritoneal mesothelioma patients may be more susceptible to damage.
  • Fatigue: Exhaustion sometimes lasts all day. It can impact nearly all chemotherapy patients. It may even result in depression or insomnia.
  • Hair Loss: Hair cells rapidly divide in our bodies and are very susceptible to damage from chemo. Hair loss is one of the most common side effects.
  • Low Blood Counts: Chemotherapy can decrease blood cell counts. This may lead to a weakened immune system, fatigue and diminishing ability to form blood clots.
  • Mouth Sores: Chemotherapy drugs can damage cells inside the mouth. This causes problems with a patient’s teeth and gums, including painful sores.
  • Nausea and Vomiting: About 70% to 80% of chemo patients experience nausea and vomiting during therapy. Some experience it several days later.

Catching side effects early makes them easier to control. Rapid treatment can prevent them from becoming more severe. Although rare, some chemo side effects are more serious. These require careful monitoring. 

Rare side effects include:
  • A fever higher than 100.5 degrees Fahrenheit
  • Bloody stool or urine
  • Intense headaches
  • Shortness of breath
  • Unexplained bruising

These symptoms can indicate an infection or reaction to a medication. Consult a doctor immediately if you experience any of these symptoms.

Some patients may think side effects are an indication that treatment is or isn’t working. Dr. Raja Mudad, medical director of the chemotherapy treatment unit at the Sylvester Comprehensive Cancer Center in Miami, explained that this isn’t the case. 

“There is absolutely no relationship between effectiveness and side effects,” he told The Mesothelioma Center at Asbestos.com. 

How You Can Manage Chemotherapy Side Effects

Be mindful of your treatment’s impact on your quality of life. There are options to help you be more comfortable. Your doctor can adjust therapy dosage or offer other medications based on your needs. 

Nausea and vomiting, for example, might be managed with over-the-counter solutions. For more severe symptoms, your doctor may prescribe medications. These may include anti-nausea medicines such as palonosetron (Aloxi), aprepitant (Emend) and ondansetron (Zofran).

3 Tips for Managing Side Effects:
  1. Ask About Nutrition: Pemetrexed lowers the body’s folic acid and B12 levels. Talk to your doctor about your nutritional needs or supplements to maintain nutrient levels.
  2. Journal: Record any new or changing side effects with the date, intensity and any remedies that help.
  3. Openly Communicate: Don’t try to “tough it out” for fear of missing a chemo cycle. Communicate honestly with your doctor to prevent complications.

A nutritionist can help during chemotherapy. They can develop a diet rich in healthy nutrients and foods that won’t interfere with your treatment. This kind of diet can help fight tiredness and stomach troubles. You also might need antibiotics or corticosteroids if your blood counts are low.


If you have mouth sores, a dental hygienist can help you care for them. A palliative care specialist can help coordinate your care. These doctors are experts at managing pain and side effects. You might have to see other specialists, depending on your needs.

How Is Chemotherapy Used to Treat Mesothelioma?

Doctors give chemotherapy intravenously in your bloodstream. The drugs go after the cells that grow very fast, like the ones that make up tumors. Chemo reduces mesothelioma symptoms by shrinking tumors that push on your lungs and chest. It also works to prevent cancer from returning. 

“In general, chemotherapy drugs disrupt the division of cells that divide quickly, preventing cancer cells from replicating and growing,” Dr. J. Marie Suga, an oncologist at Kaiser Permanente Vallejo Medical Center, told The Mesothelioma Center at Asbestos.com. 

How chemotherapy drugs work against mesothelioma cancer
Chemotherapy for mesothelioma penetrates cells and stops their spread.

Palliative care focuses on helping with symptoms to make you feel more comfortable. Other approaches use chemo for mesothelioma in different ways. Adjuvant chemo aims to kill cancer cells. Neoadjuvant chemo shrinks tumors before surgery. This technique improves the outcome by making tumors easier to remove.

Lots of cancer patients, more than 80%, get chemotherapy. It can’t cure mesothelioma, but it can improve symptoms. It can also improve your daily life. It might even help you live longer.

Combining Chemotherapy With Other Mesothelioma Treatments

Doctors combine chemotherapy with other treatments in a multimodal therapy plan. This approach gives you a better chance of beating cancer. It lowers the risk of cancer cells becoming resistant. 

A 2023 study published in the Journal of Clinical Oncology reported improved survival for pleural mesothelioma patients who received pembrolizumab (Keytruda) immunotherapy alongside chemotherapy. The overall response to therapy was 23% higher than chemotherapy alone.

Another method uses adhesive pads that deliver electrical fields through the skin. These Tumor Treating Fields disrupt cancer cells and slow down their growth. Before surgery, doctors might give you chemo as a neoadjuvant treatment. It shrinks the tumors and makes them easier to remove during surgery.

For peritoneal mesothelioma, a procedure called HIPEC can make a big difference. A pump delivers heated chemo inside your abdomen during surgery. After surgery you might receive more chemo, called adjuvant therapy. This therapy helps ensure the cancer doesn’t come back. A similar approach called HITHOC focuses on the chest area for pleural mesothelioma.

Dr. Jacques Fontaine and Dr. Virginia Wolf
Find a Mesothelioma Specialist
Get specialized treatment from experienced mesothelioma doctors.

What Mesothelioma Patients Can Expect During Chemotherapy Treatment

You can expect to chat with your mesothelioma specialist before chemotherapy. They’ll review your most recent tests and go over any changes. You may have a temporary port or catheter placed in your body. It removes the need for a new IV on each visit.

Most patients get two different chemo drugs every three to four weeks. This is called a cycle, and each patient’s number of cycles differs. You may stay on chemo for a few months, a year or longer. Your doctor will also schedule breaks between visits. This period lets your healthy cells recover from the chemo’s effects.

A visit takes around 30 minutes to get one drug and then up to 2 hours to get the second one. The schedule might change depending on how you’re responding to the treatment. If you have side effects, your doctor might suggest taking a break or skipping a cycle.

How Is Chemo Administered?

Doctors most often administer chemotherapy through an intravenous line into the blood. They may also give it as a heated wash during surgery. A specialist adjusts chemo to the individual patient. This therapy remains the most common treatment for mesothelioma. It involves several medications, dosage levels and administration methods.

  • Systemic Chemotherapy: Doctors or nurses administer the drugs through an IV line in a vein or a port. They may give it alone or with other therapies for mesothelioma.
  • Intraoperative Chemotherapy: Surgeons deliver intraoperative chemotherapy during surgery when the cancer site is open and exposed. They warm the chemo and use a pump to rinse the area. A drain helps to remove the fluid after treatment.

Follow-up visits begin a few weeks after completing the regimen. These will also occur if you’re on a maintenance chemotherapy plan. During follow-up visits, you can ask questions and get insight into the treatment. You can also review the pros and cons, ask about other options or whether there is a need for more cycles. Bring a family member to help with the discussion.

How Mesothelioma Patients Can Prepare for Chemo Treatment

You can prepare for your first chemotherapy treatment by making a plan. Having a plan means avoiding feeling overwhelmed or frightened during your initial visit.

Mesothelioma survivor Charles Wood said planning for his treatment was vital. 

“I knew what chemotherapy and radiation were all about,” he told The Mesothelioma Center. “I knew how important it was to get the right doctors, nurses, the expertise you need.” 

Understanding more about the process can help you prepare for chemotherapy treatment. Here are some preparation steps:

  • Ask for Assistance. Ask family and friends to help you at home and work. Extreme fatigue often follows chemotherapy treatment and you may need their help.
  • Dental Checkup. You may need a dental visit to check for signs of infection. Treatment of dental disease reduces the risk of complications during chemotherapy.
  • Expect Side Effects. Discuss chemotherapy side effects with your oncologist. You may need to pick up prescriptions for side effects before your first treatment.
  • Get Ready for Treatment. Eat a light meal, sleep well and plan for a ride to and from your appointments. Drink plenty of liquids to avoid dehydration.
  • Port Placement. Systemic chemotherapy is usually delivered through a port, catheter or pump surgically placed into a large vein.
  • Preliminary Testing. Blood and heart tests ensure your body can tolerate chemotherapy.
  • Prepare Your Home. Eliminate areas where you can injure yourself at home, such as sharp corners or tripping hazards. Wash and cook food thoroughly to reduce infection risks.

There’s no right or wrong way to prepare for treatment. It’s OK to ask your family and friends for support. Speak with your health care team about any extra steps. You may need to take precautions to avoid exposing others to bodily fluids during chemo treatment.

The medical staff at your treatment center is ready to answer any questions and address concerns. Researching your mesothelioma chemo drugs beforehand can help you feel prepared and confident.

Common Questions About Chemotherapy for Mesothelioma Patients

Is chemotherapy effective for pleural and peritoneal mesothelioma patients?

Combining chemotherapy with another modality is the most effective treatment for all types of mesothelioma. Chemo drugs pemetrexed (Alimta) and cisplatin after surgery can extend survival for pleural mesothelioma. For peritoneal mesothelioma, patients eligible for surgery undergo a heated chemotherapy treatment applied during the operation.

How much does chemo cost?

Chemotherapy is expensive and can cost an average of $10,000 per month. However, Medicare and other insurance plans typically cover much of the cost. Studies have shown that cancer treatment is less effective when patients struggle to afford it. Many cancer patients rely on financial assistance during treatment, and mesothelioma patients are no exception.

Please do not hesitate to discuss finances with your doctors and their staff. They may be able to recommend options for financial assistance such as treatment grants, Social Security Disability Insurance, VA claims, asbestos trust fund claims and mesothelioma claims.

How can chemo impact a patient’s mental health?

As many as 25% of cancer patients feel depressed during and after chemotherapy. Counselors, support groups, antidepressant medications and meditation can help patients manage these psychological effects of chemotherapy.

Some physical side effects, such as hair loss and fluctuations in weight, can cause mesothelioma patients to struggle with self-esteem, leading to depression and other mental and emotional side effects.

Can I work during chemotherapy treatment?

Your ability to work during mesothelioma chemotherapy treatment will depend on your individual experience with side effects and the demands of your job. If you have only mild side effects tolerated with a prescription or over-the-counter medication, you may be able to return to work.

However, your doctor may not clear you for work if your job involves heavy labor or risks of injury or infection. These hazards could cause severe harm while on chemotherapy. Always discuss your plan for returning to work with your doctor before taking action.

How often will I need to undergo chemotherapy sessions?

The frequency of chemotherapy sessions for mesothelioma can vary depending on the patient’s treatment plan. In general, chemotherapy is administered in cycles. One cycle is a treatment every three or four weeks. Rest periods in between allow the body to recover. Some patients require only a few months of therapy, while others stay on for a year or more.

The length and number of cycles can vary depending on the type and stage of mesothelioma and the chemotherapy drugs used. Treatment plans may be adjusted based on the patient’s response to chemotherapy and any side effects they experience. Discussing your specific treatment plan and chemotherapy schedule with your medical team is best.

Are there any alternative or complementary treatments that can be used alongside chemotherapy for mesothelioma?

Some complementary treatments can be used alongside chemotherapy for mesothelioma. These treatments can help manage symptoms and improve quality of life. Some examples include acupuncture, massage therapy and yoga. Acupuncture is a traditional practice involving thin needles inserted into specific points on the body. It may alleviate pain, nausea and other symptoms. 

Massage therapy can help reduce stress and pain and improve range of motion. Yoga combines physical postures, breathing techniques and meditation to improve overall well-being. Alternative or complementary options should not replace standard medical treatment for mesothelioma. Always talk to your doctor before starting any new therapies. They can help you decide which options are safe and appropriate for you.