Chemotherapy may be used alone or as part of a treatment plan that also involves radiation and/or surgery. It’s an essential part of mesothelioma treatment. Side effects vary from patient to patient.
Chemotherapy for Mesothelioma
Chemotherapy is often the first treatment doctors prescribe to mesothelioma patients. It is a standard treatment for all types of cancer that can extend patient survival time. Various types of chemotherapy treatment can add between 3 months and 3 years of survival. Your individual diagnosis is the most important factor in determining what kind of chemo treatment you receive. Patients with inoperable mesothelioma may benefit most from a combination of chemotherapy drugs and radiation while others might benefit more from a clinical trial.
Some scenarios that affect the way you receive chemotherapy include:
- Surgical candidates. Some patients are given chemotherapy to shrink tumors prior to surgery. This helps surgeons remove more of the patient’s mesothelioma. Chemotherapy, in this case, can make surgery more successful. Alternatively, your doctor may prescribe chemotherapy after surgery to kill left behind mesothelioma cells.
- Late-stage patients. Patients diagnosed with stage 3 or 4 mesothelioma may not be eligible for surgery. In this case, chemotherapy is often the best treatment available. If your doctor says surgery isn’t right for you, you can always seek a second opinion.
- Unresponsive patients. Some mesothelioma patients don’t respond well to certain types of treatment. It could be radiation or a certain chemotherapy drug. In these cases, your doctor may rely more heavily on chemotherapy or switch the chemotherapy drugs you are on. Mesothelioma specialists often prescribe 2 chemotherapy drugs together. The most common combination of chemotherapy drugs is pemetrexed (also referred to by its brand name Alimta) and cisplatin.
The combination of Alimta and cisplatin was the first FDA-approved chemotherapy treatment for mesothelioma. Since 2003 it has remained the standard of treatment for most mesothelioma patients. The combination alone adds a median survival time of just over 3 months. But patients who have Alimta and cisplatin with another mode of treatment can survive years past their initial prognosis.
Chemotherapy Methods and Types
Chemotherapy is administered in cycles. The cycles can be weekly, biweekly, or every 3 weeks. Patients receiving Alimta and cisplatin typically receive chemotherapy every 3 weeks. At each cycle, a nurse usually injects chemotherapy drugs into the vein. The number of cycles of chemotherapy depends on the patient. If you are not tolerating chemotherapy well, your doctor is unlikely to continue further cycles.
The length of time for 1 cycle of chemotherapy depends on the type of drug. Patients receiving cisplatin need lots of saline to hydrate the body and prevent kidney damage. Doctors accomplish this by administering the drug slowly over the course of several hours. On the other hand, it only takes about 15 minutes to receive a course of Alimta.
Mesothelioma chemotherapy can be systemic or intracavitary.
- Systemic delivery. Systemic chemotherapy is the most common method used for mesothelioma patients. Systemic chemo is given intravenously. This allows the drugs to enter the patient’s bloodstream directly. As the chemotherapy travels through the bloodstream, it kills mesothelioma cells wherever they are encountered.
- Intracavitary delivery. Intracavitary chemotherapy is when doctors deliver the drugs directly to the affected area. In pleural mesothelioma, this is called intrapleural chemotherapy. In peritoneal mesothelioma, it’s called intraperitoneal chemotherapy. Doctors first place a tube inside a cut made in the chest or abdominal wall. The doctor then delivers a high concentration of chemotherapy drugs directly to the mesothelioma tumors. The higher concentration has a stronger effect in many patients. The chemotherapy may also be heated, which doctors call hyperthermic chemotherapy. Some chemotherapy may escape into the bloodstream.
Your doctor will probably prescribe a form of multimodal treatment for your mesothelioma. Multimodal treatment simply means using more than one type of treatment to fight disease. The most common multimodal treatment is surgery and chemotherapy.
There are 3 approaches to multimodal chemotherapy that involve surgery. Each method is based on when chemotherapy is delivered with respect to surgery.
Here are the types of multimodal treatment that use chemotherapy and surgery:
- Neoadjuvant chemotherapy. Doctors administer drugs before surgery. The logic of neoadjuvant treatment is to make a patient more operable. By shrinking the tumors in the chest or abdomen first, it may be easier to complete the surgery with the maximum survival benefit.
- Adjuvant chemotherapy. Doctors administer drugs after surgery. Adjuvant chemotherapy is used to keep tumors from growing back. Chemotherapy after surgery extends survival times by killing mesothelioma cells before they form new tumors.
- Intraoperative chemotherapy. Doctors administer drugs during surgery. This procedure is most common in peritoneal mesothelioma patients in a process known as HIPEC (heated intraperitoneal chemotherapy). Intraoperative chemo, however, is also used for pleural patients. The idea is to apply chemotherapy directly to the surgical site to kill any remaining microscopic cancer cells that can’t be removed through surgery alone.
There is also an emerging form of multimodal chemotherapy that takes advantage of immunotherapy. Immunotherapy is a newer form of treatment for cancer. It’s mostly available through clinical trials.
While Alimta and cisplatin are often the standard of care for mesothelioma patients, not all patients respond well to this drug combination. There are several other chemotherapy drugs, and doctors may turn to them when Alimta and cisplatin are ineffective. Other chemotherapy drugs are being developed as part of clinical trials to find more effective solutions to mesothelioma treatment.
Drugs your doctor may prescribe include:
- Pemetrexed (Alimta®)
- Gemcitabine (Gemzar®)
- Doxorubicin (Adriamycin®)
Research has shown time and time again that a combination of chemo drugs is more effective than a single agent. Combinations of drugs work better because each drug is different. Distinct drugs attack mesothelioma differently, so using multiple drugs creates more opportunities to kill cancer cells.
Chemotherapy travels through the body killing off cancerous cells. This is often achieved by introducing these drugs into the bloodstream. Chemotherapy drugs can’t distinguish between mesothelioma cells and healthy cells in the body. Mesothelioma cells are also resilient, so chemotherapy drugs have to be strong. This means healthy cells are often innocent bystanders during chemotherapy cycles.
It’s normal for some healthy cells to be killed during chemotherapy cycles. This is one of chemotherapy’s side effects. Different drugs have different side effects, so mesothelioma patients experience side effects based on the specific drugs they receive.
Some common side effects include:
- Loss of appetite
- Weight loss
- Increased risk of infection
- Numbness in fingers or toes
- Ringing in the ears
The severity of an individual patient’s side effects also depends on the frequency and amount of chemotherapy they receive. Those who have higher doses are at a higher risk of more intense side effects, though it’s worth noting that your doctor can adjust your dose if chemotherapy becomes too much for you.
Doctors can help you fight some of the side effects of chemotherapy. Alimta, for example, depletes folic acid and vitamin B12. This can lead to side effects of weakness and fatigue. Doctors can help you combat these side effects with vitamin supplements. There are also medications to prevent nausea and diarrhea.
It’s not possible here to say which chemotherapy drug or method will give patients the best survival time. Alimta and cisplatin is best for many patients, but you could benefit more from a different combination. This is why finding a mesothelioma specialist is so important. Your doctor can prescribe the most effective and least harmful drug for you.
Things to remember about chemotherapy:
- It is often used with other treatments like surgery.
- Chemotherapy extends survival time in a significant way for most.
- Doctors will help you cope with side effects.
Veterans with mesothelioma have a huge support network in the VA and elsewhere. For example, our VA-accredited representative can help you find and pay for treatment. Talk to someone about these and more benefits today.