Mesothelioma Chemotherapy

Quick Summary

Chemotherapy for mesothelioma treatment is the use of anti-cancer medication to break down cancerous tumors, ease symptoms, and help patients live longer. Mesothelioma patients who receive just chemotherapy can expect to live 12 months on average after diagnosis. When chemotherapy is combined with surgery and/or radiation therapy, however, patients may live for years or even decades. Chemotherapy side effects vary from patient to patient.

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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.

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 available 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 Delivery

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 for mesothelioma patients.

Intracavitary Delivery

Intracavitary chemotherapy is when doctors deliver the drugs directly to the affected area.

  • Intracavitary Procedure

    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 in the 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. At 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.

Did you know

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.

Multimodal Chemotherapy

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:

  1. Neoadjuvant chemotherapy: Doctors administer drugs before surgery to shrink tumors in the chest or abdominal cavity. This makes the overall surgery process easier.
  2. 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.
  3. 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 and 40% of patients in the study and 85% were alive 1 year after beginning treatment.

Types of Mesothelioma Chemotherapy

Chemotherapy drugs your doctor may prescribe include:

  • Pemetrexed (Alimta®)
  • Cisplatin
  • Gemcitabine (Gemzar®)
  • Doxorubicin (Adriamycin®)
  • Vinorelbine
  • Carboplatin
  • Mitomycin

Mesothelioma Chemotherapy Combinations

Research has shown time and time again that a combination of chemotherapy drugs is more effective than a single agent.

Did you know

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 can’t distinguish between mesothelioma cells and healthy cells in the body. For this reason, it’s 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:

  • Bruising
  • Constipation
  • Diarrhea
  • Fatigue
  • Increased risk of infection
  • Loss of appetite
  • Nausea
  • Numbness in fingers or toes
  • Ringing in the ears
  • Weight loss

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 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.

Mesothelioma Veterans Guide
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Access Mesothelioma Chemotherapy

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.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

View 9 Sources
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  6. Cancer Research U.K. (2018, February 22). Chemotherapy tests. Retrieved from
  7. Chen, D., Zhang, Y., et. al. (2016). Intrapericardial bevacizumab safely and effectively treats malignant pericardial effusion in advanced cancer patients. Oncotarget, 7(32), 52436–52441. doi:10.18632/oncotarget.9420
  8. Cinausero, M., & Ardizzoni, A. (2018, January). Chemotherapy treatment in malignant pleural mesothelioma: A difficult history. Retrieved September 28, 2020, from
  9. University of Texas M. D. Anderson Cancer Center. (2021, July 14). Drug combination shows meaningful responses for malignant peritoneal mesothelioma patient. Retrieved August 16, 2021, from
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