How Is Chemotherapy Used to Treat Mesothelioma?
Chemotherapy, which is commonly referred to as “chemo,” is used to treat mesothelioma with two goals in mind:
- Controlling tumor growth: Chemotherapy drugs kill the cancer cells that create tumors. The treatment can shrink tumors and prevent or limit new tumor growth. This is how chemotherapy helps mesothelioma patients live longer.
- Reducing symptoms: Chemotherapy also reduces mesothelioma symptoms such as chest pain and difficult breathing by shrinking tumors pressing against the lungs and chest wall.
Although chemotherapy can’t cure mesothelioma, it can alleviate symptoms, improve quality of life and prolong survival. Doctors can also use chemo in combination with surgery, radiation therapy or an emerging treatment such as immunotherapy.
Cancer specialists can tailor chemotherapy to the circumstances of individual patients. The therapy remains the most common form of treatment for mesothelioma because it involves several medications, dosage levels and methods of administration.
How Chemotherapy Drugs Are Administered
- Systemic chemotherapy is delivered intravenously through a vein or a port. It circulates throughout the entire body, which exposes healthy and cancerous cells to chemotherapy. This delivery method may cause more side effects, but it is less invasive than chemotherapy delivered during surgery. Systemic chemotherapy may be administered alone, which is the most common treatment for all types of mesothelioma, or in combination with other treatments.
- Intraoperative chemotherapy is delivered during surgery within the body cavity where the cancer formed. This localized application of chemotherapy targets the cancer more directly and spares the rest of the body from exposure to chemotherapy, which reduces the risk of side effects.
Chemotherapy in a Multimodal Treatment Plan
For patients diagnosed with early-stage mesothelioma and who are healthy enough to withstand aggressive cancer treatment, chemotherapy is often combined with other treatments such as surgery and radiation therapy. This is called multimodal therapy, and it offers a chance at long-term survival.
Doctors use the following terms for the timing of when chemotherapy for mesothelioma is delivered.
- Neoadjuvant chemotherapy is delivered systemically before surgery to shrink tumors and make them easier to remove.
- Intraoperative chemotherapy is delivered locally during surgery to directly expose cancer cells to chemotherapy.
- Adjuvant chemotherapy is delivered systemically after surgery to prevent local cancer recurrence.
Intraoperative chemotherapy is only available at top cancer centers, while systemic chemotherapy can be administered at hospitals and other medical facilities.
Heated Chemotherapy Delivered During Surgery
Chemotherapy drugs administered during surgery are heated to increase effectiveness. For peritoneal mesothelioma patients, combining this type of chemotherapy with surgery has been established as the best treatment approach.
The hyperthermic intraperitoneal chemotherapy (HIPEC) procedure involves removing as much cancer tissue as possible through surgery. Afterward, a heated chemotherapy solution is pumped into the abdominal cavity for 60–90 minutes while the patient is still on the operating table.
Because the solution is confined to the abdominal cavity, its side effects are minimal.
According to a 2020 study published in American Journal of Surgical Pathology, 77.8% of peritoneal mesothelioma patients treated with cytoreductive surgery and heated chemotherapy at MD Anderson Cancer Center in Houston survived longer than five years.
A similar type of heated chemotherapy procedure, called hyperthermic intrathoracic chemotherapy (HITHOC), has been tried in the chest cavity for pleural mesothelioma. However, there is considerable debate over its effectiveness.
Tumor Treating Fields for Mesothelioma
Tumor Treating Fields for mesothelioma uses electrical fields to limit cancer growth. The treatment travels through adhesive pads attached to the skin, and doctors prescribe the therapy alongside chemotherapy. The electrical fields prevent growth in cancer cells, and patients report skin irritation as the most common side effect.
What to Expect During Chemotherapy Treatment
Your oncologist will determine which drugs you get, the dosage and frequency.
Chemotherapy is given at regular intervals called cycles. For mesothelioma patients, this usually means you will receive a dose of two chemotherapy drugs followed by weeks without treatment. This break in treatment allows healthy cells to recover from the effects of chemotherapy.
Your chemotherapy schedule may change based upon your response to chemotherapy. If you develop concerning side effects, your doctor may recommend that you delay or skip your next cycle.
The Chemotherapy Process
While chemotherapy procedures always differ from patient to patient, here’s a typical timeline of what to expect from your first consultation to the end of treatment.
Discuss the decision to start chemo for mesothelioma with your medical team and your family. Make sure your diagnosis and blood work has been analyzed by an experienced mesothelioma specialist, and ask your doctors plenty of questions, so you fully understand the pros and cons of chemotherapy.
Doctors often prescribe drugs ahead of time to reduce chemotherapy side effects. Many patients will need to have a port, catheter or pump inserted in them before they can receive systemic chemotherapy. Arrange for a ride to and from your first session.
Doctors start with three or four cycles of chemo treatment, administered approximately every three weeks. After taking your vitals and verifying the dosage, a nurse will supervise each treatment. Treatment typically includes 30 minutes of one drug, then up to two hours of a second drug.
Follow-up visits will begin a few weeks after you complete the entire regimen. You can ask more questions at follow-up visits, get insight into the treatment, discuss its success or failure and whether more treatments are recommended. Bring a family member to help with the discussion.
3 Tips Before Starting Chemotherapy
- Research the drugs your doctor is recommending and all known side effects.
- Write down all questions you have about chemotherapy to ask your oncologist.
- Discuss alternatives with your oncologist. Is a lower dosage a possibility? What’s the backup plan if it doesn’t work or if the drug is too harsh?
Preparing for Chemotherapy
- Preliminary testing: You will undergo blood and heart tests to ensure your body can tolerate chemotherapy.
- Port placement: Systemic chemotherapy must be 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. Proper treatment of dental infections reduces risk of complications during chemotherapy.
- Expect side effects: Discuss managing possible 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 assistance for daily duties.
- Get ready for treatment: Drink plenty of liquids to avoid dehydration. Eat a light meal before treatment. Get enough sleep to arrive well-rested, and plan for a ride to and from your sessions.
Chemotherapy Drugs for Mesothelioma
Mesothelioma doctors currently use or have tested several chemotherapy drugs to treat mesothelioma.
Most Common Mesothelioma Chemo Drugs
Clinical trials for mesothelioma show that tumors respond better to a combination of two chemotherapy drugs compared to just one drug. Adding a third drug has not proven more effective, so mesothelioma chemotherapy almost always involves the use of two drugs.
The most effective combination has proven to be cisplatin and pemetrexed, which is also known by the brand name Alimta. These drugs are used for “first-line chemotherapy,” which is the medical terminology for a patient’s first regimen of chemotherapy.
If the cancer starts growing again after completion of first-line treatment, different drug combinations will be used for another regimen called second-line chemotherapy. These drugs may include Alimta with carboplatin or gemcitabine with cisplatin.
Similar drug combinations used for first- and second-line chemotherapy are used for intraoperative heated chemotherapy.
Heated Chemotherapy Drugs
- Cisplatin and doxorubicin
Chemotherapy Side Effects
Although chemotherapy is the most effective treatment for killing mesothelioma cells, it carries severe side effects.
Most common side effects include:
- Nausea and vomiting
- Mouth sores
- Diarrhea and constipation
- Hair loss
- Confusion and forgetfulness (also known as “chemo brain”)
- Low blood cell counts
Fatigue affects nearly all cancer patients who undergo chemotherapy, causing them to consistently feel exhausted.
You can manage mild fatigue by getting adequate sleep, taking short naps and performing regular light exercise. If fatigue makes 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.
If you feel faint, dizzy or short of breath, or if your fatigue results in depression or insomnia, call your doctor. They may need to adjust your treatment.
Nausea and Vomiting
Nausea and vomiting occur in 70% to 80% of chemotherapy patients. These symptoms may occur immediately after the drugs are administered or be delayed by several days, and they may disappear within hours or last up to a week.
Patients often struggle to maintain a healthy weight while fighting nausea or bouts of vomiting. As an added complication, the symptoms of pleural mesothelioma can also make swallowing food difficult.
It is important to keep hydrated and consume small portions of foods that are easy to digest. You can manage nausea with prescription medications, including palonesetron (Aloxi), aprepitant (Emend) and ondansetron (Zofran). You should call your doctor if your nausea and vomiting is severe.
Chemotherapy drugs can damage cells inside the mouth, causing problems with a patient’s teeth and gums. Patients may also experience painful sores inside the mouth if dental hygiene is poor before treatment.
Seeing a dentist a month before beginning treatment can help prevent sores. A teeth cleaning is a start, but the dentist can also 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
Chemotherapy drugs often irritate the gastrointestinal tract lining, causing diarrhea and constipation. Peritoneal mesothelioma patients may be more susceptible to these side effects because of cancer-related damage and regular irritation to this part of the body.
You can manage these symptoms with antidiarrheal medications or laxatives, which are available at most drugstores. Simple changes, such as drinking more water and eating more fruits and vegetables, may also help relieve these side effects.
Hair loss is perhaps the most common side effect associated with chemotherapy. Unlike the others, unfortunately, it is not treatable. Because hair is one of the most rapidly dividing healthy cells in our bodies, it is very susceptible to damage from chemotherapy drugs.
Some patients choose to wear wigs, and some insurance plans will help defray the costs of purchasing wigs.
Chemo brain may involve forgetfulness, foggy thoughts and other forms of cognitive impairment. Many chemotherapy patients experience varying degrees of cognitive impairment ranging from mild to severe. Chemo brain is short lived in some patients, while others experience chemo brain symptoms for months or years. Coping tips and strategies help patients manage these symptoms.
Low Blood Counts
Chemotherapy drugs can trigger a decrease in blood-cell counts several days after the first dose of treatment. A drop in white blood cells (neutropenia) weakens the immune system; a reduction of platelets (thrombocytopenia) lowers the blood’s ability to clot, and a drop in red blood cells (anemia) causes fatigue.
Rare Side Effects
- Bloody stool or urine
- Fever higher than 100.5 F
- Unexplained bruising
- Shortness of breath
- Intense headaches
Consult a doctor immediately if you experience any of those symptoms.
Certain side effects of chemo for mesothelioma are more serious and should be carefully monitored. These symptoms can indicate a negative reaction to medication or an infection.
Patients who experience severe problems from their chemotherapy are encouraged to report them to the U.S. Food and Drug Administration (FDA). Patients can file a report on the FDA website to help researchers more effectively tailor future treatment.
Mental Health Side Effects
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, up to 25% of cancer patients report feeling depressed during and after treatment. Counselors, support groups, antidepressant medications and meditation can help patients manage these psychological effects of chemotherapy.
Managing Side Effects
Patients should monitor their health closely for signs of side effects. Catching and treating them early makes them easier to control and prevents them from progressing into more serious side effects.
Ask your oncologist for a referral to a palliative care specialist. These doctors are experts at managing side effects and controlling cancer symptoms including pain.
Hidden Side Effect: Financial Toxicity
Another little known side effect is financial toxicity, which refers to “problems a cancer patient has related to the cost of treatment,” according to the National Cancer Institute. Studies have proven cancer treatment is less effective when patients struggle to afford it, and medical professionals are paying more and more attention to this issue.
Many cancer patients must rely on financial assistance during treatment, and mesothelioma patients are no exception.
Do not be reluctant to discuss any problems that you are experiencing during chemotherapy treatments with your doctors and their staff.
Common Questions About Chemotherapy for Mesothelioma
- Is chemotherapy effective for pleural and peritoneal mesothelioma patients?
The most effective treatment for all forms of mesothelioma involves a combination of chemotherapy with another modality. In pleural mesothelioma, the combination of chemotherapy drugs pemetrexed (Alimta) and cisplatin, when given after surgery, has been successful in extending survival. For peritoneal mesothelioma, patients who are eligible for surgery undergo a heated chemotherapy treatment applied during the operation.
- How does chemotherapy impact mesothelioma life expectancy?
Factors affecting mesothelioma life expectancy include a patient’s diagnosis, eligibility for treatment and overall health. In a 2019 study, patients who received chemotherapy alone survived an average of 9.5 months. Median survival for patients who received a combination of surgery and chemotherapy was 12.2 months. Median life expectancy without any treatment is seven months.
- What are the alternatives to chemotherapy for mesothelioma treatment?
Mesothelioma treatment options, besides chemotherapy, include surgery, radiation, Tumor Treating Fields and therapies available through clinical research trials. Some patients choose to supplement their care with complementary medicine such as yoga, massage therapy and nutritional counseling. These can improve symptoms and outcomes of conventional treatments.
- Is chemotherapy worth it?
Chemotherapy can be a long and challenging process for patients living with mesothelioma and their loved ones. However, mesothelioma survivors across the nation share countless stories of the fulfilling lives they’ve led with the extra time allowed thanks to chemotherapy.
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