What Is Maintenance Therapy?

Mesothelioma maintenance therapy is ongoing treatment with medication after the tumors have responded to the first phase of treatment. 

Maintenance therapy aims to prevent recurrence or delay the growth of cancer cells following primary mesothelioma treatment. Some patients may remain on  maintenance therapy for long periods depending on their body’s response. 

Ongoing research is investigating the value of maintenance therapy for mesothelioma to determine which therapies are most effective. The U.S. Food and Drug Administration has yet to approve any drugs for maintenance therapy, but mesothelioma specialists still recommend maintenance therapy to patients.

Types of Maintenance Therapy

The types of maintenance therapy for mesothelioma include chemotherapy, immunotherapy and targeted therapies. These therapies are available at the nation’s top mesothelioma cancer centers.

Maintenance chemotherapy, sometimes called continuous therapy or switch-maintenance therapy, has been studied the most in mesothelioma.  According to research, Alimta alone is not an effective maintenance therapy drug for mesothelioma. But investigators continue to evaluate Alimta, along with the medication Gemzar, for potential benefits.

A 2021 phase II study published in The Lancet investigated switch-maintenance chemotherapy in pleural mesothelioma patients. After initial treatment with Alimta and cisplatin or carboplatin, half the participants switched to Gemzar and supportive care. The other half received only supportive care. The Gemzar group lived three months longer, and their tumors didn’t progress as quickly as the supportive care group. They also enjoyed a better quality of life.

Maintenance immunotherapy and targeted therapy are less understood than maintenance chemotherapy for mesothelioma. However, specialists recommend these treatments to patients who meet certain eligibility criteria. For example, patients who do not respond well to chemotherapy may be considered for immunotherapy and targeted therapy drugs.

How Do Maintenance Therapies Treat Mesothelioma?

Maintenance therapy drugs control mesothelioma growth and spread in various ways. 

Chemotherapy drugs can directly kill mesothelioma cells to control tumor growth. Immunotherapy drugs trigger a response that helps the immune system find and kill mesothelioma cells. Targeted therapy drugs home in on certain molecules involved in mesothelioma growth. For example, some drugs block the growth of new blood vessels that allow tumors to grow and spread.

Patients become eligible for maintenance therapy after completing the first treatment(s) recommended by their mesothelioma doctor. Initial treatments vary among patients, from surgery to immunotherapy to chemotherapy, and follow-up maintenance therapy recommendations are affected by the primary treatment. 

Other eligibility criteria may include certain biomarkers found in blood tests, the patient’s response to primary treatment and their overall health.

Common Maintenance Medications

Mesothelioma maintenance medications include chemotherapy, immunotherapy and targeted therapy drugs. 

Maintenance chemotherapy drugs for mesothelioma include:
  • Alimta (pemetrexed)
  • Cisplatin
  • Gemzar (gemcitabine)
Maintenance immunotherapy drugs for mesothelioma include:
  • Keytruda (pembrolizumab)
  • Opdivo (nivolumab)
  • Yervoy (ipilimumab)

Avastin (bevacizumab) is the primary drug for targeted maintenance therapy. Physicians administer Avastin with cisplatin and Alimta initially. Some patients stay on Avastin for up to a year as maintenance therapy after completing chemotherapy. Despite the need for more research on maintenance therapy drugs, most mesothelioma specialists recommend them to patients.

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Side Effects

The most common side effects of mesothelioma maintenance therapy are fatigue, digestive issues, fever and muscle or joint pain. Other potential side effects may include:

  • Diarrhea or constipation
  • Liver issues
  • Low blood cell counts
  • Mouth sores
  • Nausea or vomiting
  • Skin irritation or rash
  • Weight loss

The side effects of maintenance therapies are generally less severe than primary treatments because patients often receive a lower dose of medication. 

Coping with side effects is an important aspect of palliative care. Palliative care is supplementary to traditional treatments and may  involve prescription medications to reduce digestive issues, treat skin conditions and alleviate other side effects. Tell your doctor about any worsening side effects sooner rather than later to get help and support in your treatment journey.

What to Expect When Getting Maintenance Therapy

Your experience with maintenance therapy for mesothelioma depends on the type of therapy your doctor recommends. How therapy is administered, how long you need to take it and whether maintenance therapy is combined with other treatments varies greatly.

For example, chemotherapy, immunotherapy and certain targeted therapies are provided through an IV infusion given in cycles with breaks in between. Other targeted therapy drugs come in pill form. You can expect your doctor to closely monitor your health with blood tests and imaging scans while on maintenance therapy to ensure it is working. Maintenance therapy can’t cure mesothelioma, but it may help keep cancer in remission longer.

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How to Prepare for Maintenance Therapy

To prepare for mesothelioma maintenance therapy, establish a support system. A network of family, friends and neighbors can help when you need assistance. You can rely on others for help around the house or traveling to medical appointments. It is also important to let your employer’s human resources department know about your ongoing treatment for more support and understanding at work.

In addition, those receiving chemotherapy should plan to protect household members from exposure to bodily fluids which may contain toxic chemotherapy drugs.

Common Questions Associated With Maintenance Therapies

How is maintenance chemotherapy different from other types of chemotherapy?

Maintenance chemotherapy is often less intense than initial rounds of chemotherapy because it usually involves one drug instead of two, and may involve a lower dose.

Is maintenance therapy painful?

Certain maintenance therapy plans may involve painful side effects such as an infection, nausea, muscle pain and weakness.

Is maintenance therapy expensive?

Certain forms of maintenance therapy, such as newer immunotherapy or targeted therapy drugs, may be more expensive than maintenance chemotherapy drugs. Your health insurance provider should be able to help you understand your out-of-pocket costs.

When do doctors decide to stop maintenance chemotherapy?

Your doctor may decide to stop maintenance chemotherapy if you experience serious adverse side effects or if the cancer progresses significantly.

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