Chemotherapy for Mesothelioma Patients
Chemotherapy is a standard treatment for mesothelioma. Mesothelioma chemotherapy involves using drugs to destroy cancer cells. A popular option is the mix of cisplatin and pemetrexed (Alimta). This treatment is usually given for several hours over 21 days.
Written by Dr. Daniel A. Landau Edited By Walter Pacheco Medically Reviewed By Dr. Jacques Fontaine
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Landau, D. A. (2023, June 2). Chemotherapy for Mesothelioma Patients. Asbestos.com. Retrieved June 5, 2023, from https://www.asbestos.com/treatment/chemotherapy/
Landau, Daniel A. "Chemotherapy for Mesothelioma Patients." Asbestos.com, 2 Jun 2023, https://www.asbestos.com/treatment/chemotherapy/.
Landau, Daniel A. "Chemotherapy for Mesothelioma Patients." Asbestos.com. Last modified June 2, 2023. https://www.asbestos.com/treatment/chemotherapy/.
What Is Chemotherapy for Malignant Mesothelioma?
Chemotherapy is a cancer treatment that uses chemicals. These drugs kill cancer cells and prevent them from multiplying. They can harm cancerous and healthy cells. Chemotherapy is often used as a first-line treatment for mesothelioma.
Doctors may administer chemo alone or in combination. Common pairings are surgery or radiation therapy. This can help shrink tumors, reduce symptoms and improve quality of life. The typical chemo drugs for mesothelioma are cisplatin and pemetrexed (Alimta).
Drug choice depends on the patient’s diagnosis and response to treatment. This treatment has shown the most potential to extend survival in patients. Other drugs or targeted therapy may be helpful in combination with cisplatin. Some are effective as a single agent.
Doctors choose the proper chemotherapy regimen for each patient based on several factors. These include the stage and location of cancer, general health and medical history. Doctors also consider any previous treatments the patient may have received. They may also regard the patient’s age and other medical conditions.
Are All Mesothelioma Patients Eligible for Chemo?
Not all patients are eligible for chemotherapy. It may not be the best treatment option for everyone. Some drugs can have more severe side effects. Older patients or those with specific health issues may prefer less aggressive alternatives.
Patients with advanced mesothelioma may not benefit as much from chemotherapy. Some may not be eligible due to medical conditions. Others may be unable to tolerate the therapy. Each patient should discuss their wishes with their medical team. Together, you can choose the best course for your situation.
How Is Chemotherapy Used to Treat Mesothelioma?
Doctors use chemotherapy, or “chemo,” to control tumor growth. These drugs travel through the blood. They target fast-growing cells. This includes the cells that rapidly divide to create tumors.
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 can ease symptoms. Making patients more comfortable is known as palliative care.
Adjuvant chemo aims to kill cancer cells. Palliative chemo can ease symptoms. Neoadjuvant chemo helps other treatments work better. Neoadjuvant treatments help reduce the size of tumors before surgery.
More than 80% of cancer patients receive chemotherapy. Chemotherapy can’t cure mesothelioma. It can alleviate symptoms. It can also improve quality of life and prolong survival.
Combining Chemotherapy With Other Mesothelioma Treatments
Doctors sometimes combine chemotherapy with other treatments. This multimodal therapy offers a better chance of long-term survival. The approach limits cancer cells from becoming resistant to treatment. A newer method involves adding Tumor Treating Fields. TTFields use electrical fields through adhesive skin pads to limit cancer growth.
Doctors may prescribe chemotherapy before surgery as a neoadjuvant treatment. This approach shrinks tumors and makes them easier to remove surgically. Chemotherapy given after surgery is called adjuvant therapy and prevents cancer regrowth.
A heated pump can also deliver chemo during surgery. The chemo drugs “wash” the surgical site. This hyperthermic intraperitoneal chemotherapy procedure, known as HIPEC, can dramatically improve survival for peritoneal mesothelioma patients. Hyperthermic intrathoracic chemotherapy, or HITHOC, is a similar approach for pleural mesothelioma.
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. These work best in patients who have not had prior cancer therapy. Second-line drugs are preferred for repeat treatments if cancer returns.
The most popular combination of mesothelioma chemo drugs is cisplatin and Alimta. Research shows this is the best choice for first-line mesothelioma.
Clinical trials for mesothelioma show that tumors respond better to two drugs. Drug combinations are also effective during intraoperative heated chemotherapy. The most common choices are cisplatin, doxorubicin and mitomycin C.
Depending on allergies, cancer cell type and medical history, your doctor may choose other chemotherapy drugs or combinations. Cancer may return after you complete first-line treatment. In this case, your doctor may prescribe different drug combinations for second-line chemotherapy.
What Mesothelioma Patients Can Expect During Chemotherapy Treatment
Your oncologist will determine the appropriate chemo drugs, dosage and frequency. They base this on your cancer type and stage. First, you’ll have a consultation with a mesothelioma specialist. Then, you’ll 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. You’ll receive these every three to four weeks. Thes 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. Your doctor may recommend delaying or skipping a cycle if you develop concerning side effects.
How Is Chemo Administered?
Doctors can deliver chemotherapy through an intravenous line into the blood or as a heated wash during surgery. Cancer specialists can tailor chemotherapy to the circumstances of individual patients. 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. Doctors may administer systemic chemotherapy alone, the most common treatment for all types of mesothelioma malignancy. They may also deliver it in combination with other therapies.
- Intraoperative Chemotherapy: Surgeons deliver intraoperative chemotherapy during surgery. This is when the cancer site is open and exposed. This technique requires warming the chemotherapy and using a pump to rinse the cancer site with the medication. A drain helps to remove the fluid after treatment.
Follow-up visits begin a few weeks after completing the regimen. During follow-up visits, you can ask questions and get insight into the treatment. You can also review the 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 Chemotherapy for Mesothelioma Take?
Administering chemotherapy drugs usually takes between 30 minutes and two hours. However, prepare to spend an extra hour before and after treatment. This time is 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. 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 over four months. Your specialist will discuss with you if they recommend a maintenance chemotherapy plan.
Side Effects of Chemotherapy for Mesothelioma
While chemotherapy is the most effective treatment for malignant mesothelioma, side effects are common. Some can be severe. Patients should monitor their health closely for adverse reactions.
- Chemo Brain: Many chemotherapy patients experience varying degrees of memory loss or confusion. 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 lasts throughout the 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 perhaps the most common side effect.
- 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 chemotherapy patients experience nausea and vomiting during therapy. Some experience it several days later.
Catching side effects early makes them easier to control. Combined with rapid treatment, this prevents them from becoming more severe. Although rare, some chemo side effects for mesothelioma are more serious. These require careful monitoring.
- 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 an adverse reaction to a medication. Consult a doctor immediately if you experience any of these symptoms.
How You Can Manage Chemotherapy Side Effects
Be mindful of your treatment’s impact on your quality of life. Typically, side effects can be managed to help you be more comfortable. 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. These may include anti-nausea medicines such as palonosetron (Aloxi), aprepitant (Emend) and ondansetron (Zofran).
- Ask About Nutrition: Pemetrexed lowers the body’s folic acid and B12 levels. Talk to your doctor about your nutritional needs. Ask if supplements could help you maintain nutrient levels and prevent side effects.
- Journal: Record any new or changing side effects with the date, intensity and any remedies that help.
- Openly Communicate: Don’t try to “tough it out” with any side effects you may experience for fear of missing a chemo cycle. Communicate honestly with your doctor. They can help ensure your overall health and prevent complications.
A nutritionist can help plan a nutrient-rich diet with chemo-friendly foods. This diet can help combat fatigue and digestive side effects. Antibiotics or corticosteroids may be required for issues like low blood counts. A dental hygienist can help manage mouth sores. You may also require visits to additional specialists.
A palliative care specialist can help coordinate your care. These doctors are experts at managing side effects and controlling cancer symptoms, including pain.
How Mesothelioma Patients Can Prepare for Chemo Treatment
Gather your thoughts and make a plan to avoid feeling overwhelmed during your initial visit. You likely won’t feel entirely prepared for your first chemotherapy treatment. Not knowing how you’ll react to the medication can be frightening.
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 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.