What Is Chemotherapy?

Chemotherapy treatment uses drugs to stop or limit the growth of cancer cells, either killing the cells or preventing them from dividing. These drugs use cytotoxic chemical substances, harming both cancerous and healthy cells.

Depending on cancer type and stage, doctors may give chemotherapy drugs orally, as an injection or intravenously. Cancer patients may receive chemotherapy alone or in combination with other treatments, such as surgeryradiation therapy or emerging treatments, including Tumor Treating Fields, targeted therapy or immunotherapy.

How Is Chemotherapy Used to Treat Mesothelioma?

Doctors use chemotherapy, commonly known as “chemo,” to control mesothelioma tumor growth. These medications travel through the blood, targeting fast-growing cells, including those that rapidly divide to create tumors. 

As chemotherapy shrinks tumors pressing against the lungs and chest wall, it reduces mesothelioma symptoms such as chest pain and difficulty breathing. The use of chemotherapy to ease symptoms and make patients more comfortable is known as palliative care.

How chemotherapy drugs work against mesothelioma cancer

In addition to adjuvant chemo that aims to kill cancer cells and palliative chemo that is used to ease symptoms, neoadjuvant chemo helps other treatments work better. Neoadjuvant treatments are often administered to help reduce the size of tumors before surgery.

More than 80% of cancer patients receive chemotherapy. Although chemotherapy can’t cure mesothelioma, it can alleviate symptoms, improve quality of life and prolong survival.

Combining Chemo With Other Mesothelioma Treatments

Doctors sometimes combine chemotherapy with other treatments in multimodal therapy, which offers a better chance of long-term survival. This approach reduces the risk that cancer cells become resistant to treatment. A newer method involves adding Tumor Treating Fields that use electrical fields through adhesive skin pads to limit cancer growth. 

Doctors may prescribe chemotherapy before surgery as neoadjuvant treatment, shrinking tumors and making them easier to remove surgically. A heated pump can also deliver chemotherapy during surgery, treating cancer cells intraoperatively, “washing” the surgical site. 

This hyperthermic intraperitoneal chemotherapy (HIPEC) procedure can dramatically improve survival for peritoneal mesothelioma patients. Chemotherapy given after surgery is called adjuvant therapy and prevents cancer regrowth. The hyperthermic intrathoracic chemotherapy (HITHOC) is a similar approach for pleural mesothelioma.

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Chemotherapy Drugs Used for Mesothelioma

Mesothelioma doctors use chemotherapy drugs differently. Each medication has benefits and drawbacks. Patients with a new diagnosis receive mesothelioma chemotherapy drugs designed for first-line treatment, which work best in patients with no prior cancer therapy. Second-line drugs are preferred for repeat treatments. 

The most popular combination of mesothelioma chemotherapy medications is cisplatin and pemetrexed, which has the brand name Alimta. Research shows this is the best choice for first-line mesothelioma chemotherapy treatment. 

Clinical trials for mesothelioma show that tumors respond better to a combination of two drugs. The drug combinations for first- and second-line chemotherapy are also effective during intraoperative heated chemotherapy. The most common choices for heated chemotherapy are cisplatin, doxorubicin and mitomycin C.

Depending on allergies, cancer cell type and medical history, your doctor may choose other chemotherapy drugs or combinations. If cancer returns after you complete first-line treatment, your doctor may prescribe different drug combinations for second-line chemotherapy. 

What to Expect During Chemotherapy Treatment

Your oncologist will determine the appropriate chemo drugs, dosage and frequency based on your cancer type and stage. After a consultation with a mesothelioma specialist, patients first undergo blood work and a dental exam to check for signs of disease. Most patients also receive a port or catheter placement for drug administration. 

For mesothelioma patients, treatment cycles are typically two chemotherapy drugs every three to four weeks. These breaks in treatment allow healthy cells to recover from the effects of chemotherapy. 

Treatment typically includes 30 minutes of one medication, then up to two hours of a second drug. Your chemotherapy schedule may change based on your response to the treatment. If you develop concerning side effects, your doctor may recommend delaying or skipping a cycle.

How Is Chemo Administered?

Cancer specialists can tailor chemotherapy to the circumstances of individual patients. This therapy remains the most common treatment for mesothelioma because it involves several medications, dosage levels and administration methods. Doctors can deliver chemotherapy through an intravenous line into the blood or as a heated wash during surgery. 

  • Systemic Chemotherapy: During a systemic mesothelioma chemotherapy regimen, doctors or nurses administer the drugs through an IV line in a vein or a port. Doctors may administer systemic chemotherapy alone, the most common treatment for all types of mesothelioma malignancy, or in combination with other therapies.
  • Intraoperative Chemotherapy: Surgeons deliver intraoperative chemotherapy during surgery when the cancer site is open and exposed. This technique requires warming the chemotherapy, using a pump to rinse the cancer site with the medication, and a drain to remove the fluid.

Follow-up visits begin a few weeks after completing the regimen. During follow-up visits, you can ask questions, get insight into the treatment, review pros and cons and discuss whether or not there is a need for more cycles. Bring a family member to help with the discussion.

How Long Does Chemo Take?

Administering chemotherapy drugs usually takes between 30 minutes and two hours. However, it’s best to prepare to spend an extra hour before and after treatment in case your health care team needs to perform additional tests or monitor you for longer. 

A treatment cycle is usually one visit about every three to four weeks. The number of cycles you receive will depend on your treatment history and tolerance to the medication. Some patients require just a few months of chemotherapy, while others may stay on the therapy for a year or longer.  

Mesothelioma chemotherapy doses are administered approximately every 21 days or every three to four weeks. First-line chemotherapy usually includes six treatment visits, or an average of just over four months, to complete chemotherapy treatment for mesothelioma.

Your specialist will discuss with you if they recommend a maintenance chemotherapy plan.

Side Effects of Chemotherapy

While chemotherapy is the most effective treatment for malignant mesothelioma, side effects are common, and some can be severe. Patients should monitor their health closely for adverse reactions. 

Common side effects include:
  • Chemo Brain: Many chemotherapy patients experience varying degrees of cognitive impairment. Chemo brain can be short-lived or last for years.
  • Diarrhea and Constipation: Chemotherapy often irritates the gastrointestinal tract lining. Peritoneal mesothelioma patients may be more susceptible to damage.
  • Fatigue: Exhaustion, sometimes lasting throughout the day, impacts nearly all chemotherapy patients and can result in depression or insomnia.
  • Hair Loss: Hair cells rapidly divide in our bodies and are very susceptible to damage from chemotherapy. Hair loss is perhaps the most common side effect.
  • Low Blood Counts: Chemotherapy can decrease blood cell counts, causing a weakened immune system, fatigue and diminishing ability to form blood clots.
  • Mouth Sores: Chemotherapy drugs can damage cells inside the mouth, causing problems with a patient’s teeth and gums that can also include painful sores.
  • Nausea and Vomiting: About 70% to 80% of chemotherapy patients experience nausea and vomiting, either during drug administration or several days later.

Catching side effects early, combined with rapid treatment, makes them easier to control and prevents them from becoming more severe. Although rare, some side effects of chemo for mesothelioma are more serious and require careful monitoring. 

Rare side effects include bloody stool or urine, a fever higher than 100.5 degrees F, unexplained bruising, shortness of breath and intense headaches. These symptoms can indicate an infection or an adverse reaction to a medication. Consult a doctor immediately if you experience any of these symptoms.

Managing Chemotherapy Side Effects

Typically side effects can be managed to help patients be more comfortable. Be mindful of your treatment’s impact on quality of life. Your mesothelioma specialist can adjust therapy to your individual needs. 

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

3 Tips for Managing Side Effects:
  1. Ask about nutrition: Pemetrexed lowers folic acid and B12 levels in the body. Talk to your doctor about your nutritional needs and if supplements might help maintain nutrient levels and prevent side effects.
  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” with any side effects you may experience for fear of missing a chemo cycle. Communicating honestly with your doctor can help ensure your overall health, preventing complications.

Antibiotics or corticosteroids may be required for issues like low blood counts. You may also require visits to additional specialists. A nutritionist can help plan a diet rich in nutrients with chemo-friendly foods to help combat fatigue and digestive side effects. A dental hygienist, for example, can help manage mouth sores. 

palliative care specialist can help coordinate your care. These doctors are experts at managing side effects and controlling cancer symptoms, including pain.

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How to Prepare for Chemo Treatment

You likely won’t feel entirely prepared for your first chemotherapy treatment, and not knowing how you’ll react to the medication can be frightening. Gather your thoughts and make a plan to avoid feeling overwhelmed during your initial visit.

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

  • Preliminary Testing: Blood and heart tests ensure your body can tolerate chemotherapy.
  • Port Placement: Systemic chemotherapy is usually delivered through a port, catheter or pump surgically placed into a large vein.
  • 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 that treat side effects before your first treatment.
  • 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.
  • 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.
  • Get Ready for Treatment: Drink plenty of liquids to avoid dehydration. Eat a light meal, get enough sleep and plan for a ride to and from your appointments.

There’s no right or wrong way to prepare for treatment. It’s okay to ask your family and friends for support. Speak with your healthcare team about any extra steps you’ll need to take to avoid exposing others to bodily fluids during your 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. In pleural mesothelioma, the chemotherapy drugs pemetrexed (Alimta) and cisplatin after surgery can extend survival. For peritoneal mesothelioma, patients eligible for surgery undergo a heated chemotherapy treatment applied during the operation.

Who is eligible for chemotherapy for mesothelioma?

After a mesothelioma diagnosis, your doctor will determine whether chemotherapy is the best treatment for you based on your mesothelioma cell type, previous therapies and overall health. The best candidates for mesothelioma chemotherapy are healthy enough to withstand side effects and multiple cycles of treatment.

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.

Do not be reluctant 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 report feeling 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 prescription or over-the-counter medication, there is a good chance you can 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. 

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