Mesothelioma Chemotherapy

Chemotherapy can be a frightening treatment to consider, but this therapy is recognized as one of the few treatment options that can be effective for mesothelioma patients. Chemotherapy cannot cure mesothelioma, but depending on the severity of the cancer, chemotherapy can alleviate symptoms, improve quality of life and prolong survival. For patients who are not candidates for surgery and are diagnosed with Stage 3 or 4 mesothelioma, a major treatment decision is often whether or not to undergo chemotherapy.

Why Chemotherapy?

The primary objective of chemotherapy is to kill cancer cells and shrink tumors. It attacks cells which are rapidly dividing and interrupts the division process. While chemotherapy is meant to target cancer cells, it can harm any cells throughout the body that divide quickly. For example, hair follicles are among the fastest growing cells and therefore are easily damaged during chemotherapy treatment, leading many cancer patients to experience temporary hair loss.

Chemotherapy relieves symptoms of mesothelioma by effectively reducing tumor size, and may lessen the risk of spread (metastasis) or extend life expectancy. Treatment plans for chemotherapy can vary depending upon the type of mesothelioma you are diagnosed with, as pleural and peritoneal mesothelioma patients may receive different drugs and methods of administration.

Therapy Options

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

Types of Mesothelioma Chemotherapy Application:

• Systemic Chemotherapy - Medication is either injected into a vein or swallowed in pill form. The medication enters the bloodstream and systemically circulates throughout the body.
• Intrapleural or Intraperitoneal Chemotherapy - The drug is administered through a small tube straight into the body cavity where the cancer is developing. Medication still enters the bloodstream, but the greatest concentration is absorbed in the area where cancer cells reside.

Chemotherapeutic drugs are given in cycles. The duration, frequency and total number of cycles will vary from patient to patient. Chemotherapy plans can be implemented in the following ways:

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Mesothelioma Chemotherapy Treatment Plan Options:

• Chemotherapy alone - Chemotherapy is the only treatment the patient undergoes.
• Multimodal therapy with chemotherapy - In this approach, chemotherapy is combined with one or more other treatments, such as surgery radiation therapy.
• Neoadjuvant chemotherapy - Before a patient undergoes surgery, chemotherapy is used to reduce tumor size.
• Adjuvant chemotherapy - A method that applies chemotherapy after surgery to reduce the risk of recurrence.
• Palliative chemotherapy - This treatment aims to relieve symptoms of mesothelioma with chemotherapy and may be paired with another treatment such as radiation therapy.

Chemotherapy Drugs for Mesothelioma

Chemotherapy drugs for mesothelioma 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 combination of chemotherapeutic drugs for pleural mesothelioma treatment is Alimta (pemetrexed) paired with cisplatin.

Commonly used chemotherapy drugs for mesothelioma include:

• Cisplatin
• Gemcitabine
• Alimta
• Carboplatin
• Onconase
• Navelbine

Other chemotherapy drugs applied in the treatment mesothelioma have included methotrexate, vincristine, vinblastine, mitomycin, doxorubicin, epirubicin, cyclophosphamide and ifosfamide.

Single Agent and Combination Chemotherapy

Single agent

Single agent chemotherapy uses one anticancer medication to treat cancer. Over the course of many clinical trials, mesothelioma patient response rates to single agents have typically been very low, ranging from 0 percent to 15 percent in most studies. In unique cases, sometimes involving high doses of a medication, response rates have increased. Chemotherapy medications that have been used as single agents for mesothelioma include cisplatin, carboplatin and doxorubicin.

Combination chemotherapy

Combination chemotherapy involves the use of two or more anticancer medications. Recent studies have shown positive results in mesothelioma patients undergoing this type of chemotherapy. As mentioned previously, the combination of cisplatin and pemetrexed can be an effective treatment option for mesothelioma patients.

Study Spotlight:
In a 2003 Phase III clinical trial testing the combination of pemetrexed and cisplatin versus the single use of cisplatin, 448 mesothelioma patients received chemotherapy. A total of 226 patients received pemetrexed and cisplatin while 222 received cisplatin alone. Results demonstrated that the combination of pemetrexed and cisplatin was more effective in terms of survival (12.1 months vs. 9.3 months), median time to progressive disease (5.7 months vs. 3.9 months) and response rate (41 percent vs. 17 percent).

Other chemotherapy combinations previously applied in the treatment of mesothelioma include cisplatin and doxorubicin, cisplatin and mitomycin, and cisplatin with gemcitabine. Triple-drug combinations have not demonstrated better results than two-drug combinations.

Clinical trials on combination chemotherapy have revealed beneficial results for mesothelioma patients. Many of these studies have reported a survival advantage with the combination of cisplatin and other chemotherapy drugs. More importantly, clinical trials testing the effects and response rates of chemotherapy are gradually increasing the knowledge of specialists that study mesothelioma treatment.

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First Line and Second Line Chemotherapy

First line chemotherapy offers the most favorable approach to treating 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.

Side Effects of Chemotherapy

Although chemotherapy is often used in conjunction with other treatments such as surgery and radiation therapy, chemotherapy can act as a first line treatment option for mesothelioma patients who are not candidates for surgery. Before considering chemotherapy as a treatment option for mesothelioma, it is important for patients to become familiar with the side effects:

Side Effects of Chemotherapy:

• Hair loss
• Nausea and vomiting
• Lower platelet count
• Compromised immune system
• Body aches
• Tingling in the feet and hands

• Anemia (decrease of red blood cells)
• Loss of appetite
• Constipation or diarrhea
• Rash
• Fatigue
• Fever

Chemotherapy for Peritoneal Mesothelioma

Study spotlight:
In a study of 50 peritoneal mesothelioma patients who were healthy enough to undergo surgery and perioperative (meaning before or after surgery) intraperitoneal chemotherapy, three-year and five-year survival rates were 54 percent and 44 percent, respectively.

Chemotherapy for peritoneal mesotheliomapatients differs from the type of chemotherapy given to pleural mesothelioma patients. Known as “intraperitoneal chemotherapy,” the method inserts a high drug concentration directly into the peritoneal cavity, but generally poor penetration into tumors.

Studies of intraperitoneal drug delivery have shown that direct tumor absorption occurs at a level of only a few millimeters from the surface. As a result, hyperthermic intraperitoneal chemotherapy (HIPEC), also known as heated chemotherapy, may be an option for peritoneal mesothelioma patients. The high temperature of the solution increases the effectiveness of the medication to hopefully prolong survival and reduce pain.

Find a Specialist

It's important for anyone battling mesothelioma to engage a specialist to help in that fight. Speaking with a mesothelioma doctor about chemotherapy options will offer the best information for your unique case. Feel free to use our Doctor Match Program to find a specialized doctor near you. Call (800) 615-2270.

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Author: Karen Selby

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.