Chemotherapy breaks down cancerous tumors, relieves symptoms, and helps patients live longer. Patients who undergo chemotherapy can expect to live 12 months on average after diagnosis. However, patients may live for years or even decades with chemotherapy, surgery, and/or radiation therapy.
Chemotherapy for Mesothelioma
If you or a loved one has mesothelioma, chemotherapy will likely be a part of the treatment. Chemotherapy is often the first treatment oncologists (cancer doctors) prescribe to mesothelioma patients.
Various types of mesothelioma chemotherapy can add between three months and three years to your lifespan. Your individual diagnosis and overall health are the most important factors that affect the kind of chemotherapy treatment you receive.
Mesothelioma doctors often prescribe two chemotherapy drugs together, with the most common combination being pemetrexed (also referred to by its brand name Alimta®) and cisplatin. There are several other chemotherapy drugs that doctors can also use if pemetrexed and cisplatin are ineffective.
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When Is Chemotherapy Used?
- With Surgery: Some cancer patients are given mesothelioma chemotherapy to shrink tumors prior to surgery. This helps surgeons remove more of the cancer. Your cancer care provider may also prescribe chemotherapy after surgery to kill microscopic mesothelioma cells that may remain.
- In Late-Stage Cancer Patients: Patients diagnosed with stage 3 or 4 mesothelioma may not be eligible for surgery. In this case, chemotherapy is often the best treatment to improve quality of life. If your doctor says surgery isn’t right for you, you can always seek a second opinion.
- If Other Treatments Don’t Work: Some mesothelioma patients don’t respond well to certain types of treatment. It could be radiation or a certain chemotherapy drug. In these cases, doctors may use second-line chemotherapy drugs, which are alternatives to commonly used treatments that may be more helpful.
Administering Mesothelioma Chemotherapy
Mesothelioma chemotherapy can be delivered in one of two ways.
Systemic chemotherapy 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. Systemic chemotherapy is the most common method used to treat mesothelioma patients.
Intracavitary chemotherapy is when doctors deliver the drugs directly to the affected area.
Doctors first place a tube inside the chest or abdominal wall. The doctor then delivers a high concentration of chemotherapy right to the mesothelioma tumors. This often has a stronger effect than systemic chemotherapy.
In malignant pleural mesothelioma, this is called intrapleural chemotherapy. In peritoneal mesothelioma, it’s called intraperitoneal chemotherapy.
Patients can receive mesothelioma chemotherapy in a cancer center, at an outpatient clinic, or sometimes at home.
Mesothelioma Chemotherapy Cycles
Chemotherapy is administered in cycles. The cycles can be weekly, biweekly, or every three weeks. Patients receiving pemetrexed and cisplatin typically receive chemotherapy every three weeks. During each cycle, a nurse injects chemotherapy drugs into the vein.
The number of cycles of chemotherapy depends on the patient. If you are not tolerating mesothelioma chemotherapy well, your doctor is unlikely to continue further cycles.
The length of time for one 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 pemetrexed.
Your doctor will probably prescribe mesothelioma chemotherapy alongside other treatments in a multimodal therapy plan. Multimodal therapy simply means using several treatment options together to fight disease. The most common multimodal treatment is surgery and chemotherapy.
There are three approaches to multimodal chemotherapy that involve surgery:
- Neoadjuvant chemotherapy: Doctors administer drugs before surgery to shrink tumors in the chest or abdominal cavity. This makes the overall surgery process easier.
- Adjuvant chemotherapy: Doctors administer chemotherapy drugs after surgery to keep tumors from growing back. Chemotherapy after surgery extends survival times by killing mesothelioma cells before they form new tumors.
- Intraoperative chemotherapy: Here, doctors apply heated chemotherapy during surgery to kill any microscopic cancer cells that weren't removed through surgery. This procedure is most common in peritoneal mesothelioma patients in a process known as cytoreduction with HIPEC (hyperthermic intraperitoneal chemotherapy). Intraoperative chemo, however, is also used for pleural mesothelioma patients.
There is also an emerging form of multimodal chemotherapy that takes advantage of immunotherapy. Immunotherapy is a newer form of treatment for cancer that harnesses the body's immune system to fight cancer.
A recent clinical trial combined an immunotherapy drug called atezolizumab with bevacizumab, a form of chemotherapy, to treat peritoneal mesothelioma. This combination was very effective. Tumors shrunk in 40% of patients in the study, and 85% were alive 1 year after beginning treatment.
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Types of Mesothelioma Chemotherapy
Chemotherapy drugs your doctor may prescribe include:
- Doxorubicin (Adriamycin®)
- Gemcitabine (Gemzar®)
- Pemetrexed (Alimta®)
Mesothelioma Chemotherapy Combinations
Research has shown time and time again that a combination of chemotherapy 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.
Cisplatin and pemetrexed is the standard mesothelioma chemotherapy combination, according to the American Cancer Society (ACS). It was the first FDA-approved chemotherapy treatment for mesothelioma. Since 2003, it has remained the standard of treatment for most mesothelioma patients.
The combination of pemetrexed and cisplatin adds about three more months to a patient’s lifespan than if just cisplatin is used. Patients who have pemetrexed and cisplatin with another mode of treatment can survive years past their initial prognosis.
Chemotherapy Side Effects
Chemotherapy drugs cannot distinguish between mesothelioma cells and healthy cells in the body. As a result, it is normal for some healthy cells to be killed during chemotherapy cycles, which leads to side effects.
Mesothelioma patients will experience different side effects based on the type of chemotherapy they receive.
Common side effects of cisplatin and pemetrexed include:
- Increased risk of infection
- Loss of appetite
- Numbness in fingers or toes
- Ringing in the ears
- Weight loss
The severity of a patient’s side effects also depends on the frequency and amount of chemotherapy they receive. Those with higher doses are at a greater risk of more intense side effects. Your doctor can adjust the dose if chemotherapy becomes too much for you.
Doctors can help you fight some of the side effects of chemotherapy. Pemetrexed, for example, depletes folic acid and vitamin B12. This can lead to side effects of weakness, fatigue, and diarrhea. Doctors can prescribe vitamin supplements to ease these side effects. There are also medications to prevent nausea and diarrhea.
If you are a veteran who has been receiving chemotherapy treatments following a mesothelioma diagnosis, you may be entitled to additional benefits from the U.S. Department of Veterans (VA). Request a copy of our free Veterans Packet to learn more.
After a mesothelioma diagnosis, it's crucial to find the best treatment options — including chemotherapy — for your case. 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:
- Chemotherapy may help improve your survival time.
- It is often used with other treatments like surgery.
- Doctors can help you manage side effects.
Veterans with mesothelioma have a huge support network in the VA and elsewhere. Through the VA, veterans can access low-cost or free mesothelioma treatments and work with some of the top specialists in the country.
To learn more about the treatment options available to you, get a Free Veterans Packet today.