Literally meaning "chemical therapy," the term "chemotherapy" refers to the treatment of any disease with some sort of drug or "chemical." However, it is better known specifically as a way to treat cancer. It is often recommended for the treatment of mesothelioma, either by itself, before or after surgery, or along with radiation therapy. The use of multiple types of therapy is known as multimodal treatment.
Simply put, chemotherapy works to stop the multiplication of cancer cells by killing them. Cancer cells, unlike healthy cells, grow out of control and develop into tumors that impair organ function. The chemotherapy drugs are all designed to stop this rampant growth.
For pleural mesothelioma patients, some chemotherapy drugs work better than others, and there are more than 100 such drugs currently on the market. Chemotherapy does not offer a cure for mesothelioma patients, but it can buy time. Scientists continue to invent new treatments to combine with chemotherapy that are increasing the life span of those with pleural mesothelioma.
Chemotherapy can cause serious side effects, but it can extend survival for many people with pleural mesothelioma. It can be frightening to consider chemotherapy treatment. Thankfully, modern medicines and therapies are helping patients manage symptoms better than in the past.
Process of Chemotherapy
Chemotherapy may be suggested as the primary treatment for some pleural mesothelioma patients, especially those who are not candidates for surgery. For those who are able to undergo surgery, it may be used beforehand to shrink tumors as much as possible or afterward to kill any remaining cancer cells. The stage of the disease and the patient's overall health will help determine how chemotherapy is used.
Patients will learn all about how their chemotherapy treatment will go at an initial consultation visit with the cancer doctor, also known as an oncologist. The oncologist will review the patient’s medical history, all cancer-related tests and perform a physical exam. The doctor will also discuss how chemotherapy will be administered and how to respond to side effects. The consent form will be explained and patients will schedule their first chemotherapy appointment.
Chemotherapy is given in hospitals, cancer centers and chemotherapy centers. Chemotherapy medicine may be delivered intravenously (through a vein) or in pill form, and doctors will determine which is right for you. Administering chemotherapy in these forms represents "systemic" chemotherapy, which means the medicine travels throughout the body in search of cancer cells that it can destroy. The biggest concern with systemic chemotherapy is that it also kills healthy cells, resulting in a range of side effects.
Intravenous is the most common form of chemotherapy administration for pleural mesothelioma. It is given in cycles of once every several weeks followed by a break. The exact schedule of administration and how long the drug is given during chemotherapy sessions will vary for each patient depending upon their health and treatment plan.
Before chemotherapy is given the patient’s vitals are taken, weight and height are recorded to ensure the proper amount of chemotherapy is used, and blood samples may be collected to document red and white blood cell counts. Medicine to prevent nausea and fluids may be given. After the drug is administered for several minutes or hours and the IV is taken out, the patient’s vitals are taken again and a nurse or doctor will review how to deal with side effects. Anti-nausea and other medications for side effects may be prescribed.
Patients may feel fatigued after chemotherapy and should plan on resting after receiving treatment. Dehydration and constipation are counteracted by water, so drink plenty of fluids after chemotherapy. Avoid crowds and sick people because the immune system will be compromised. If any severe side effects develop, contact your oncologist immediately.
To reduce the toxic effects of chemotherapy and to better target specific tumors, doctors have developed new ways to deliver chemotherapy medicines. Pleural mesothelioma patients, for example, may be candidates for intrapleural chemotherapy, which injects the chemotherapeutic drug directly into the pleura at the site of the tumor. This localized approach spares the rest of the body from chemotherapy, but doesn’t allow the drug to reach any cancerous cells that may have spread outside of the pleura. Spreading cells can go on to develop tumors elsewhere, hence the benefit of systemic chemotherapy.
Chemotherapy and Pleural Mesothelioma
Chemotherapy medicines are often administered in pairs. Currently, the most widely used chemotherapy pairing for the treatment of pleural mesothelioma cancer is a combination of pemetrexed, also known by its brand name Alimta, and cisplatin. These are the only chemotherapy drugs that are FDA-approved for the treatment of pleural mesothelioma.
A 2003 phase III trial discovered about 41 percent of pleural mesothelioma patients respond to the combination of pemetrexed and cisplatin. Experts note that folate and vitamin B12 must be given when this combination is used because pemetrexed interferes with the normal metabolism of these vital nutrients. Toxicity is reduced with vitamin supplementation and the median survival for trial participants who received B12 and folate was 13.3 months.
Other chemotherapy drugs most commonly used in the treatment of pleural mesothelioma include:
Carboplatin is a platinum-based drug like cisplatin, but it tends to cause fewer side effects. A 2006 phase II trial on the combination of carboplatin and pemetrexed in 102 pleural mesothelioma patients reported a complete response in two patients, meaning their tumors completely disappeared. Tumors shrank for of 18.6 percent of participants, and 47 percent had no new tumor growth after treatment. Median overall survival time was 12.7 months.
Gemcitabine is often given as second-line chemotherapy or to patients who don’t easily tolerate platinum-based drugs like cisplatin and carboplatin. A 2002 phase II trial on the combination of gemcitabine and cisplatin reported a 33 percent response rate, which means the tumors shrank to some degree but didn’t disappear.
Doxorubicin is another second-line chemotherapy drug option for recurring pleural mesothelioma. In 2011, results were published from a phase II trial on doxorubicin combined with valproic acid (an anticonvulsant that kills mesothelioma cancer cells) in 45 pleural mesothelioma patients. Tumors shrank in 16 percent of participants, and 36 percent had no new tumor growth. Median survival was 16.7 months for the 16 percent of participants with tumor shrinkage.
Vinorelbine is another second-line chemotherapy drug that works for some people with pleural mesothelioma. A 2009 study of 63 people with relapsed pleural mesothelioma reported that vinorelbine shrunk tumors for 16 percent of participants and overall survival was 9.6 months.
Your doctor will determine which are most appropriate for you. If you do not tolerate a particular drug, a switch can usually be made. Effectiveness of any of these drugs will depend on a variety of factors including the stage of the cancer and your overall health. New chemotherapy drugs are constantly being developed and some are showing promise in the fight against pleural mesothelioma.
Side Effects of Chemotherapy for Pleural Mesothelioma
The side effects of chemotherapy can be difficult to tolerate, though some side effects have been lessened with newer chemotherapy drugs. Newer pain and anti-nausea medications are better at controlling some side effects.
Nevertheless, it is a difficult therapy to tolerate and patients need to be closely monitored by their doctor in order to avoid any life-threatening consequences. Most side effects of chemotherapy will cease when the therapy is complete, but others may take longer to disappear or may be permanent. Many can be addressed with medications.
Common side effects include:
- Low white blood cell count (leaving the patient prone to infection)
- Loss of appetite
- Extreme fatigue
- Fever and chills
- Hair loss
- Low platelet count and clotting concerns
- Generalized achy feeling
- Tingling hands and feet
- Depression or anxiety
All side effects should be reported to your doctor, especially the development of a high fever, signs of infection, or the presence of blood in the urine. Decreased ability to eat because of side effects should also be noted because it is important for chemotherapy patients to maintain a healthy diet rich in protein and nutrients.