The most common chemotherapy drugs for mesothelioma are Alimta and cisplatin. But doctors may use different drugs depending on your diagnosis.
Different Chemotherapy Drugs for Mesothelioma
When treating mesothelioma, doctors typically use a combination of 2 chemotherapy drugs. The combination of drugs improves survival times more than the use of a single drug because each chemotherapy drug affects mesothelioma in different ways.
Drugs your doctor may prescribe include:
- Pemetrexed (Alimta®)
- Doxorubicin (Adriamycin®)
- Gemcitabine (Gemzar®)
- Raltitrexed (Tomudex®)
- Cisplatin (Platinol®)
- Vinorelbine (Navelbine®)
All of the chemotherapy drugs above have shown good results in certain cases. It is important to consult with a mesothelioma specialist who knows which drugs will work best for you.
Chemotherapy drugs can be used in 3 ways:
- First-line therapy. This is when chemotherapy is the first treatment a mesothelioma patient receives. It’s often part of a multimodal approach to be followed by surgery and/or radiation therapy. Most patients receive 4-6 cycles of chemotherapy with each cycle lasting 21 days.
- Intraoperative therapy. Patients who are healthy enough for aggressive surgery may receive chemotherapy during surgery. Intraoperative chemo can extend survival by years for peritoneal and pleural patients in some cases.
- Second-line or maintenance therapy. When a patient starts to see their condition get worse again, it’s time for second-line therapy. Your doctor may use the same chemotherapy drugs or new drugs at this stage. Maintenance therapy is chemotherapy used to prevent mesothelioma from getting worse.
Understanding Platinum-Based Chemotherapy
Platinum-based chemotherapy drugs like cisplatin have been especially important for intraoperative procedures in mesothelioma patients. Cisplatin and carboplatin are the most popular platinum-based drugs.
Drugs like cisplatin often cause the worst side effects when administered via the bloodstream. However, when surgeons bathe the chest or abdominal cavity with cisplatin, there are fewer side effects because only small amounts of the drug make it into the bloodstream. It also means surgeons can use larger, more powerful chemotherapy doses.
Platinum-based chemotherapy drugs are also essential to systemic chemotherapy. Cisplatin can kill mesothelioma cells that other drugs may leave behind.
First-line Chemotherapy Drugs
Chemotherapy is a standard treatment for all cancer types, including mesothelioma. The initial cycles of chemotherapy given to a patient are known as first-line chemotherapy.
Currently, the combination of Alimta and cisplatin are the standard first-line treatment for mesothelioma. However, doctors may recommend other drug combinations depending on their patient’s condition.
Common first-line drug combinations:
- Alimta and cisplatin. Most patients will receive this treatment. When the combination was approved by the Food and Drug Administration in 2003, it was a huge step forward. Alimta and cisplatin demonstrated a 3-month increase in overall survival. Patients who weren’t eligible for surgery arguably benefited the most from this chemotherapy combination, because there were no comparably reliable treatments available before. Used before or after surgery, Alimta and cisplatin are even more effective.
- Alimta and carboplatin. Cisplatin is a harsh drug as are most platinum-based chemotherapies, it takes several hours to administer cisplatin to ease the drug into the patient’s system. When patients are too weak, doctors often replace cisplatin with carboplatin, a less aggressive platinum-based drug that, when combined with Alimta, produces similar survival benefits to cisplatin. The combination of Alimta and carboplatin is a good option for late-stage patients who aren’t in the best health.
Patients receiving an Alimta and platinum-based therapy combination are prescribed supplements to prevent chemo side effects.
Chemotherapy Drugs Before Surgery
Some doctors prescribe first-line chemotherapy with the intent of making surgery easier. A multimodal treatment regimen using chemotherapy, surgery and radiation has shown some of the most promising survival times for mesothelioma.
Patients with no mesothelioma in their lymph nodes may live as long as 4.9 years after multimodal treatment according to a study from 2009.
There are several drug combinations that have been tested for use before surgery. This type of chemotherapy is often called induction or neoadjuvant chemotherapy.
Common induction chemotherapy drugs include:
- Alimta and cisplatin
- Cisplatin and vinorelbine
- Cisplatin and raltitrexed
- Cisplatin and gemcitabine
A 2009 study showed that each of the above combinations produced similar survival benefits when used for induction chemotherapy.
Triplet Therapy – 3 Drug Chemotherapy Combinations
Your doctor may order a combination of 3 chemotherapy drugs as your first treatment. The same principle applies as 2-drug combinations. That principle is that the additional drugs can kill different cancer cells.
A current triplet therapy combination used in mesothelioma treatment is called MVP.
This acronym stands for the drugs used, being:
- Platinum-based chemotherapy
Like many other combinations, patients receive MVP in one sitting every 3 weeks.
The H. Lee Moffitt Cancer Center in Florida has phase 2 clinical trial testing a new triplet therapy combination. The study is using a combination of cisplatin, methotrexate and gemcitabine. Eligible candidates are those who have inoperable mesothelioma. The goal of this study is to provide patients with a new, potentially life-saving treatment option. As of December 2017, the center is still recruiting new patients.
Second-line and Maintenance Chemotherapy
Many patients experience slower or reversed tumor development. Some patients even reach a full remission. Your doctor may choose from any of the chemotherapy drugs available as second-line or maintenance therapy.
When patients respond well to their initial treatments, their doctors may prescribe chemotherapy to keep them in remission. This is called maintenance therapy. And in cases where mesothelioma returns, patients often need a second series of chemotherapy cycles, known as second-line chemotherapy.
Second-line chemotherapy is also an option for patients who didn’t respond to first-line chemotherapy.
There are no standardized chemotherapy drugs for maintenance and second-line treatment, partially because of the lack of a reliable second-line therapy is also the limitations of chemotherapy in mesothelioma.
One clinical trial at Columbia University is testing new drugs for second-line mesothelioma treatment. The combination of drugs is oxaliplatin and gemcitabine. Oxaliplatin, a platinum-based drug, may be a better substitute for cisplatin or carboplatin. The researchers of this study hope that this combination will help patients who were unresponsive to other chemotherapy drugs.
Another reason is that research in recent years has shifted to novel treatments like immunotherapy. Your doctor may still decide that second-line chemotherapy offers the best chances for extended survival times.
Which Drugs Are Right for You?
There are many combinations of drugs that may help you live longer. If you’re in good health, your doctor will probably recommend the standard of care: Alimta and cisplatin. Those who may not weather side effects well could be prescribed the less aggressive carboplatin. But no matter what, the best treatment option is multimodal therapy.
Key facts about mesothelioma chemotherapy drug types:
- Some are less aggressive with fewer side effects.
- Many are being tested in combinations with other drugs.
- All chemotherapy drugs work best in combination with other treatments like surgery.
In order to receive a specialized treatment plan, you need to visit a mesothelioma cancer center. Only these specialists know the best chemo drugs for you. There are cancer centers across the country that can help. Even the VA has mesothelioma specialists who are covered by VA benefits. Our VA-accredited claims agent can connect you with a specialist in the VA or get access to benefits to pay for treatment. Get assistance from our representative now.