Mesothelioma Chemotherapy Drugs

Chemotherapy drugs are an aggressive mesothelioma treatment option effective in reducing tumors and killing cancer cells of pleural and peritoneal mesothelioma, 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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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

Medical oncologist Dr. Tirrell Johnson discusses the important role chemotherapy plays in treating mesothelioma patients.

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 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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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.

Mesothelioma Chemotherapy Side Effects

Although chemotherapy 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. While radiation and surgery typically affect the site of treatment, side effects of chemotherapy often affect the entire body.

Before considering chemotherapy as a treatment option for mesothelioma, it is important for patients to become familiar with its side effects:

  • Fatigue

    Fatigue is the most frequently reported side effect of chemotherapy and affects nearly all cancer patients who undergo this procedure. Mesothelioma patients undergoing chemotherapy may feel consistently exhausted or "drained."

    Although it is natural to feel fatigued during therapy, there are degrees of fatigue. You should call your doctor if you feel faint, dizzy or short of breath. If your fatigue results in depression or insomnia, your doctor may need to adjust your treatment. Patients can manage mild fatigue by getting adequate sleep, taking short naps and participating in light exercise.

    Even prior to treatment, mesothelioma symptoms may cause fatigue. The cancer typically affects seniors who may already be prone to fatigue. If fatigue is making it hard for you to complete chores or errands, allow friends and relatives to help with easy tasks such as grocery shopping and meal preparation.

  • Nausea and Vomiting

    Nausea and vomiting occur in 70 to 80 percent of chemotherapy patients. These symptoms can occur immediately after the drugs are administered or develop over several days. They may disappear within hours or last up to a week.

    Some drugs may be less likely to cause nausea and vomiting than others. About 90 percent of patients who use cisplatin — one of the most common drugs used to treat mesothelioma — experience these symptoms.

    Patients often struggle to maintain a healthy weight while fighting nausea or bouts of vomiting. Pleural mesothelioma can cause breathing complications, chronic cough and chest pain — making swallowing difficult. Side effects from chemotherapy only add to these difficulties. It is important keep hydrated and consume small portions of foods that are easy to digest. Nausea can also be managed with prescription medications, including Aloxi (palonesetron), Emend (aprepitant) and Zofran (ondanestron).

  • Mouth Sores

    Chemotherapy drugs can damage cells inside the mouth, causing problems with a patient's teeth and gums. Patients may find it hard to eat, drink or swallow during treatment. These side effects may add to eating difficulties for pleural and peritoneal mesothelioma patients, who often experience pain or tightness in the chest or abdomen, respectively.

    They also may experience painful sores inside of the mouth if dental hygiene is poor before beginning treatment. Seeing a dentist a month before beginning treatment can help prevent sores. A teeth cleaning is a start, but the dentist can take X-rays to spot any potential problems and give you tips on how to self-treat sore gums and mouth sores.

  • Diarrhea and Constipation

    These may occur if drugs irritate the gastrointestinal tract lining. Prolonged diarrhea can cause bodily imbalances. Diarrhea and constipation can be well managed with anti-diarrheal medications or laxatives, which are available at most drugstores. Simple changes, such as an increased fluid intake and dietary adjustments, may also help combat these effects.

    Peritoneal mesothelioma patients may be more susceptible to these side effects because of pre-existing damage and regular irritation to the gastrointestinal tract lining.

  • Hair Loss

    Hair loss is perhaps the most common side effect associated with chemotherapy. Unfortunately, unlike the others, it is not treatable. Because hair is one of the most rapidly dividing healthy cells our bodies, it is very susceptible to damage from these drugs. Some patients choose to wear wigs, which may be covered under some insurance plans.

  • Low Blood Cell Counts

    Chemotherapy drugs can also trigger a drop in blood cell count several days after the first dose of treatment. A drop in white blood cells (neutropenia/leukopenia) is most common, but these drugs can also affect platelets (thrombocytopenia) and red blood cells (anemia).

Rare But Serious Side Effects

Certain side effects of chemotherapy are more serious and should be carefully monitored. These symptoms can indicate a negative reaction to medication or an infection.

Immediately consult a doctor if you experience:

  • Fever higher than 100.5 degrees F
  • Bloody stool or urine
  • Unexplained bruising
  • Shortness of breath
  • Intense headaches

Patients who experience severe problems from their chemotherapy are encouraged to report them to the U.S. Food and Drug Administration. Patients can file a report on the FDA website to help researchers more effectively tailor future treatment.

The Hidden Side 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 emotional side effects.

In fact, between 15 and 25 percent of cancer patients report feeling depressed during and after treatment. Counselors, support groups, antidepressant medications or meditation can help patients manage these psychological effects of chemotherapy.

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

  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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