Chemotherapy for Mesothelioma
Chemotherapy is a standard treatment for mesothelioma. The most common mesothelioma chemotherapy drugs are pemetrexed (Alimta), cisplatin and carboplatin. The combination of pemetrexed and a platinum-based chemotherapy drug is the only FDA-approved chemotherapy for mesothelioma.
Can Chemotherapy Cure Mesothelioma?
While chemotherapy improves length and quality of life for people with a pleural mesothelioma diagnosis, it does not cure the disease.
Cancer cells grow, divide and multiply more rapidly than normal cells. Chemotherapy drugs for pleural mesothelioma attack these rapidly growing cells. This is why chemotherapy is recommended for many patients.
However, chemotherapy for mesothelioma offers patients the opportunity to control this aggressive cancer for better survival and improved prognosis.
Most normal cells do not grow as rapidly as mesothelioma cells, but these drugs affect some of these cells. Hair, skin and gastrointestinal tract cells are susceptible to chemotherapy.
This is reflected in the side effects some mesothelioma patients experience such as hair loss, dry skin, rashes, nausea, mouth sores and altered sense of taste.
How Is Chemotherapy Used to Treat Mesothelioma?
Chemotherapy may be used as the primary mesothelioma treatment, especially if the patient is not able to undergo mesothelioma surgery.
For mesothelioma patients who are good surgical candidates, chemotherapy may be used beforehand to shrink tumors or afterward to kill remaining cancer cells.
Some mesothelioma cancer centers also offer heated chemotherapy during surgical procedures. Known as heated intraoperative chemotherapy, this nonstandard treatment combines a macroscopic complete resection with heated chemotherapy drugs delivered directly into the area around the tumor.
HIPEC Treatment for Peritoneal Mesothelioma Patients
Patients with peritoneal mesothelioma who are eligible for surgery may also qualify for heated intraperitoneal chemotherapy. Also known as HIPEC, this procedure occurs during cytoreductive surgery and can reduce the chance of cancer recurrence.
HIPEC surgery for mesothelioma involves washing the abdominal cavity with a warmed chemotherapy solution to eliminate cancer cells left behind after surgery
Determining If You Are Eligible
The patient’s pleural mesothelioma stage and overall health will determine how and when chemotherapy is used.
Before beginning chemotherapy treatments, patients will go to a consultation visit with an oncologist. The doctor will discuss the patient’s medical history and results of a physical exam, cancer tests and scans.
A nurse also may provide extensive chemotherapy education at this time. Each patient will learn how the chemotherapy will be administered, expected side effects and information on how to best manage side effects.
Chemotherapy Drugs for Pleural Mesothelioma
Often, your doctor will prescribe two or more chemotherapies to be given together. This can provide the best cancer cell killing effect.
For pleural mesothelioma patients who are healthy enough to receive multiple chemotherapy drugs at once, the standard of care is Alimta (pemetrexed) plus cisplatin or carboplatin.
This combination of Alimta and a platinum drug is considered standard of care for pleural mesothelioma.
Although oncologists can offer other chemotherapy drugs if the standard of care is not an option, the combination of Alimta and a platinum drug is the only FDA-approved chemotherapy for the treatment of pleural mesothelioma.
If a person’s health or prior treatments prevent standard of care chemotherapy, other pleural mesothelioma treatments include:
- Gemzar (gemcitabine)
- Navelbine (vinorelbine)
- Adriamycin (doxorubicin)
Your doctor will determine which chemotherapy plan is best for you. If you do not tolerate a particular drug, they can switch you to a different medication.
A 2018 study published in OncoImmunology noted the addition of a cancer vaccine called TroVax led to a measurable immune response in the majority of recipients. The authors documented 70 percent of patients had stable disease during the short-term study.
Although this treatment is not yet available to all mesothelioma patients, the researchers recommended the chemotherapy plus cancer vaccine combination be moved to larger, phase III clinical trials.
How Is Chemotherapy Given to Each Patient?
The most common way to provide chemotherapy is through an IV. Pharmacists and nurses are involved in determining the appropriate chemotherapy dose for each patient and administering the drugs.
These procedures take place in a cancer center, chemotherapy infusion facility or in a hospital. Most chemotherapy is provided in an outpatient setting, though some patients may be admitted to the hospital for a few days if closer monitoring is part of the treatment plan.
Chemotherapy is typically given in cycles of once every few weeks followed by a break. Sessions may take minutes to several hours.
Once the chemotherapy is delivered, your nurse or doctor will check your vital signs again and discuss side-effect management. The exact treatment schedule and how long the drug is given during each session will vary for each patient, depending upon their health and optimal treatment plan.
Some patients may be eligible for oral chemotherapy, which is taken as a pill. Your oncologist will determine if it’s best for you to receive pleural mesothelioma treatments through an IV or with a pill.
Mesothelioma Chemotherapy Side Effects
The side effects of chemotherapy can be challenging, although newer pain and anti-nausea medications offer patients the ability to undergo treatment while maintaining good quality of life.
Even with excellent side-effect management, you may need to be monitored by your doctor in order to avoid any life-threatening consequences of chemotherapy.
Most side effects will decrease once therapy is complete, but others may take longer to resolve, and some may be permanent.
Ask your oncologist or nurse if you have questions about which side effects to expect, when you will experience them and how long they will last.
Being prepared and knowing what to expect will help you get the benefits of pleural mesothelioma chemotherapy while keeping side effects under control.
Common Chemotherapy Side Effects
- Loss of appetite
- Extreme fatigue, aches and pains
- Fever and chills
- Hair loss
- Low platelet count and blood clotting abnormalities
- Tingling in the hands and feet (neuropathy)
- Skin rash
- Low white blood cell count (neutropenia)
- Depression or anxiety
If your doctor expects you to experience low white blood cell counts, they will give you special instructions for minimizing your risk of infection. This may include how to prepare foods, places to avoid and special hygiene precautions.
Are Chemotherapy Side Effects Manageable?
There are many ways to manage chemotherapy side effects.
Medications, dietary changes and supportive care all help patients gain the most benefit from pleural mesothelioma chemotherapy drugs while minimizing the downsides of these treatments.
When side effects are properly managed, chemotherapy — alone or in combination with surgery and radiation therapy — offers many patients good quality of life and longer survival.
If you experience any severe side effects, especially a fever, signs of infection, or the presence of blood in the urine, call your doctor or nurse right away.
Rare and Serious Chemotherapy Side Effects
Certain chemotherapy side effects are very serious. These symptoms should be reported to your mesothelioma doctors immediately. They can signal an infection or a severe medication reaction.
Call your doctor immediately if you have:
- Bloody stool or urine
- Fever above 100.5 degrees Fahrenheit
- Unexplained bruising
- Shortness of breath
- Intense headaches
Severe chemotherapy reactions should be reported to the U.S. Food and Drug Administration. This information helps doctors and researchers more effectively tailor future treatment for all patients receiving these same chemotherapy drugs.
How Will You Feel After Chemotherapy?
Some people feel fatigued immediately after chemotherapy and should plan on resting the rest of the day. Others feel fine on the day of treatment and only experience tiredness several days later. Ask your medical care team what to expect.
To minimize the risk of dehydration and constipation, drink plenty of fluids after each chemotherapy session. This will help your body process the drugs properly and support the health of your liver and kidneys during treatment.
You may need to avoid crowds and sick people because your immune system will be compromised for a time after each cycle of chemotherapy. If you develop any severe side effects, including a fever, vomiting, difficulty breathing or extreme fatigue, contact your oncologist immediately.
Even if you are taking medications to manage side effects, you may need adjustments to those drugs. Some people require different forms of toxicity management such as a patch to diminish nausea or lessen pain instead of a pill.
Even if you are not yet experiencing side effects, take your medications exactly as prescribed. For most people, it is far easier to prevent side effects than to try to relieve them once they start.