Chemotherapy for Mesothelioma Patients

Chemotherapy is an aggressive and effective treatment option for pleural and peritoneal mesothelioma patients. Despite its side effects, more than 70 percent of cancer patients opt to undergo some type of chemotherapy.

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Patient Advocate Karen Selby explains chemotherapy to mesothelioma patients.

Despite the toxic effects of chemotherapy drugs, it remains the most common form of treatment for mesothelioma cancer patients.

Although chemotherapy can’t cure mesothelioma, it can alleviate symptoms, improve quality of life and prolong survival, depending upon the stage of the cancer when treatment begins.

The reason chemotherapy is so effective in treating mesothelioma is because it involves using toxic drugs to kill cancer cells.

It can be used either alone, or in combination as part of a multidisciplinary treatment plan that also may include surgery, radiation or one of the newest immunotherapy drug conjugants.

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Mesothelioma patients who undergo chemotherapy live more than twice as long as those who do not, according to a Wayne State University School of Medicine study done in 2016 that used data obtained from the National Cancer Institute (NCI).

Chemotherapy can be a frightening treatment to consider – harsh side effects can include hair loss, vomiting, fatigue and fever – but a personalized approach to treatment today can be effective in killing cancer cells and shrinking mesothelioma tumors.

According to one mesothelioma specialist in New York City, an estimated 70 percent of those diagnosed with mesothelioma will at least start a chemotherapy treatment regimen.

How Effective is Chemotherapy?

The primary objective of this treatment is to kill cancer cells and shrink tumors. Chemotherapy attacks cells that are rapidly dividing and interrupts the division process.

The median survival for patients who received chemotherapy treatment was 12 months, compared to just four months for those who did not, according to a 2016 Wayne State University study using the latest Surveillance, Epidemiology and End Results (SEER) database.

Combining chemotherapy with other options extended survival time even more, according to the 2016 study. Patients receiving chemotherapy, along with surgery, had a median overall survival of 16 months.

While chemotherapy is meant to target cancer cells, it can harm any cells throughout the body that divide quickly. Hair follicles, for example, are among the fastest growing cells and easily damaged during treatment, leading many mesothelioma cancer patients to experience temporary hair loss.

Chemotherapy relieves symptoms of mesothelioma by effectively reducing tumor size, lessening the risk of spread (metastasis) or extending life expectancy. Treatment plans, drugs and drug delivery for pleural mesothelioma and peritoneal mesothelioma will vary because of the locations of the tumors in those diseases.

Therapy Options

The length and type of treatment a patient receives is determined by factors such as the type of cancer, stage and extent of the cancer, patient health and type of drug administered. Mesothelioma patients receive chemotherapy systemically or directly into the body cavity where the cancer is located.

Methods of Administering Chemotherapy

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Systemic

Medication is injected into a vein or swallowed in pill form. The medication enters the bloodstream and circulates throughout the body.

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Intrapleural or Intraperitoneal

Drugs are delivered into the body cavity through a small tube. Medication still enters the bloodstream, but the greatest concentration is absorbed in the area where cancer cells are present.

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
    The patient's sole treatment.

  • Multimodal therapy
    Chemotherapy is combined with two or more treatments such as surgery and radiation therapy.

  • Neoadjuvant
    Before undergoing surgery, doctors reduce the patient's tumor size with chemotherapy.

  • Adjuvant
    Chemotherapy is delivered post-surgery to reduce the risk of recurrence.

  • Palliative
    Procedure aims to relieve mesothelioma symptoms, manage pain and may be paired with another treatment such as radiation therapy.

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Timeline of Chemotherapy

While all chemotherapy procedures differ from patient to patient, here's a typical timeline of what to expect from your first consultation to the end of treatment.

  1. Consultation

    The decision to start chemotherapy treatment should be discussed with your family doctor and with an experienced oncologist. Family members also should be consulted. Ask your doctors questions so you fully understand the pros and cons of the treatment. You don’t want surprises. Blood work will be done before it begins.

  2. Planning for Treatment

    Doctors often will prescribe drugs to begin ahead of time to reduce side effects of the chemotherapy. Patients receiving intravenous chemotherapy, which is common, will need to have a port, catheter or pump inserted to deliver the chemotherapy. Everyone reacts differently to treatment, so make sure you have a ride to and from your first session.

  3. Treatment

    A common chemotherapy cycle for mesothelioma will start with three or four rounds. They will be administered approximately every three weeks. Treatments are typically supervised by a nurse. A combination chemotherapy treatment will typically include 30 minutes of one drug, then up to two hours of a second drug. Tests are often performed during treatment to ensure ideal effectiveness.

  4. Post-Treatment

    Follow-up visits will begin a few weeks after the entire regimen is completed. This is a time to ask more questions, get insight into the treatment, discuss the success or failure and whether more treatments are recommended. Bring along a family member to help with the discussion.

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 chemotherapy drug combination for pleural mesothelioma treatment is Alimta (pemetrexed) with cisplatin.

The pemetrexed/cisplatin combination is likely to continue as the standard, first-line treatment regimen for patients with inoperable pleural mesothelioma, according to another recent study at the Shizuoka Cancer Center and Juntendo University in Japan.

Researchers there found a synergistic effect when the two drugs are used together, while other combinations of chemotherapy were less effective.

Immunotherapy, targeted therapy, photosensitizing and anti-angiogenesis drugs also are used in combinations on various levels. Chemotherapy agents are powerful and effective, but they attack all cells — healthy and cancerous — causing a variety of side effects.

Most Common Mesothelioma Chemotherapy Drugs

Fast Fact: 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 anti-cancer medication. Over the course of many clinical trials, mesothelioma patient response rates to single agents have typically been low, ranging from zero to 15 percent in most studies. In unique cases, sometimes involving high doses of a medication, response rates have increased. Chemotherapy medications used as single agents for mesothelioma include cisplatin, carboplatin and doxorubicin.

Combination

Combination therapy involves the use of two or more anti-cancer medications. Recent studies show positive results in mesothelioma patients undergoing this type of chemotherapy.

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.

Want to learn more about clinical trials?

First Line and Second Line

First-line chemotherapy offers the most favorable approach to treating mesothelioma 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.

Peritoneal and Pleural Intraoperative Chemotherapy

Survival Rate of Patients Who Undergo Surgery and Perioperative Intraperitoneal Chemotherapy

Surgery and Perioperative Intraperitoneal Chemotherapy

Chemotherapy for peritoneal mesothelioma patients differs from the chemotherapy given to pleural mesothelioma patients because of the location of the tumors. One method, intraperitoneal chemotherapy, involves inserting a high concentration of the drugs directly into the peritoneal cavity, but the penetration into tumors is generally poor. Studies of intraperitoneal drug delivery have shown direct tumor absorption occurs only a few millimeters from the surface.

Hyperthermic intraperitoneal chemotherapy (HIPEC), also known as heated chemotherapy, has been especially effective when given immediately after cytoreductive surgery.

The procedure involves pumping a heated chemotherapy solution into the abdominal cavity, allowing it to circulate for approximately 60-90 minutes, and then draining it before the patient leaves the operating room.

The high temperature of the solution increases the effectiveness of the medication, while the medical staff massages the patient’s abdomen, making sure the chemotherapy solution is distributed to evenly throughout the abdomen. In essence, the heated chemotherapy will kill any tiny tumor cells the surgeon missed.

Because the solution is confined only to the abdominal cavity, its side effects are minimal.

A 2014 Washington Cancer Institute study published in the Annals of Surgical Oncology showed the success of process. Peritoneal mesothelioma patients who relapsed had good results when they repeated the procedure two and three times, according to the retrospective analysis. The median overall survival was 77 months for those undergoing the procedure the first time, and 55 months for those who repeated it.

“I would do it again, without hesitation,” said mesothelioma survivor Jacob Hess, who was diagnosed in 2010. “The way it was explained to me it was an excellent option to go along with the surgery. It just made sense. Everyone is different, and nothing is 100 percent certain, but I have to believe that the clean checkups I’ve been getting have a lot to do with the HIPEC.”

A similar type of procedure has been tried in the chest cavity with pleural mesothelioma and heated chemotherapy, but there still is considerable debate over its effectiveness.

Study Spotlight: Survival rate of patients who were healthy enough to undergo surgery and perioperative (meaning before or after surgery) intraperitoneal chemotherapy.

Need Money for Treatment?

If you or a loved one has been diagnosed with mesothelioma, you may be eligible for financial assistance.

Side Effects of Mesothelioma Chemotherapy

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

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.

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 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. Some insurance plans will help defray the costs.

Low Blood Counts

Chemotherapy drugs can also trigger a drop in blood count several days after the first dose of treatment. A drop in white blood cells, which is common, may cause neutropenia or leukopenia. These drugs can also affect platelets, causing thrombocytopenia, and red blood cells, which can lead to 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.

Consult a doctor immediately if you experience:

  • Bloody stool or urine
  • Fever higher than 100.5 degrees F
  • 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.


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

  1. http://www.cancer.org/Cancer/MalignantMesothelioma/DetailedGuide/malignant-mesothelioma-treating-chemotherapy
  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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