Mesothelioma Chemotherapy Drugs

The most common chemotherapy drugs for mesothelioma are Alimta and cisplatin. Doctors can identify the right chemotherapy drugs for patients depending on the type of mesothelioma they have, how advanced the disease is, and other factors related to their current health conditions

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Different Chemotherapy Drugs for Mesothelioma

a patient sits in a chair and receives chemotherapy

When treating mesothelioma, doctors typically use a combination of two chemotherapy drugs. The combination of drugs improves survival times more than using a single drug because each chemotherapy drug affects mesothelioma differently.

Drugs your doctor may prescribe include:

  • Cisplatin (Platinol®)
  • Carboplatin
  • Doxorubicin (Adriamycin®)
  • Gemcitabine (Gemzar®)
  • Mitomycin
  • Pemetrexed (Alimta®)
  • Raltitrexed (Tomudex®)
  • Vinorelbine (Navelbine®)

A new chemotherapy drug called pegarginimase (ADI-PEG20), which is being tested in clinical trials, has shown positive results for patients battling pleural mesothelioma. A study published in JAMA Oncology in February 2024 found that the drug quadrupled 3-year survival rates.

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 three ways:

  • First-line therapy. This is when chemotherapy is the first treatment a mesothelioma patient receives. It is often part of a multimodal approach followed by surgery and/or radiation therapy. Most patients receive four to six 21-day cycles of chemotherapy.
  • 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 or new chemotherapy drugs at this stage. Maintenance therapy is chemotherapy used to prevent mesothelioma from getting worse.

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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 is 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 three-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 in order 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 in poor health.

Did you know?

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, radiation, and surgery has shown some of the most promising survival times for mesothelioma.

Several drug combinations 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 gemcitabine
  • Cisplatin and raltitrexed
  • Cisplatin and vinorelbine

Three-Drug Chemotherapy Combinations

Your doctor may order a combination of 3 chemotherapy drugs as your first treatment. The same principle applies to two-drug combinations — 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:

  • Mitomycin
  • Platinum-based chemotherapy
  • Vinblastine

Like many other combinations, patients receive MVP during one session every three weeks.

Second-Line and Maintenance Chemotherapy

Many patients experience slower or reversed tumor development. Some patients even reach full remission. Your doctor may choose from any 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. In cases where mesothelioma returns, patients often need a second series of chemotherapy cycles, known as second-line chemotherapy.

chemotherapy treatment

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. This is partially because of the limitations of chemotherapeutic drug activity in mesothelioma.

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?

Many combinations of drugs may help you live longer. If you are 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.

Key facts about mesothelioma chemotherapy drug types:

  • Some are less aggressive with fewer side effects.
  • Many are being tested in combination with other drugs.
  • In earlier stages of the disease, chemotherapy drugs work best in combination with other treatments like surgery.

In order to receive a specialized treatment plan, you should visit a mesothelioma cancer center. There are cancer centers across the country that can help.

The U.S. Department of Veterans Affairs (VA) partners with mesothelioma specialists whose care costs 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. Call (877) 450-8973 now for assistance on how to get started.

Veterans can also take advantage of our free Veterans Packet for in-depth information on various medical treatment options, mesothelioma specialists nationwide, and special benefits and resources for you through your illness.

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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.

  1. American Cancer Society. "Chemotherapy for Malignant Mesothelioma." Retrieved from: Accessed on March 8, 2024.
  2. National Cancer Institute. "Drugs Approved for Malignant Mesothelioma." Retrieved from: Accessed on March 8, 2024.
  3. Perlmutter Cancer Center. "Chemotherapy for Malignant Mesothelioma." Retrieved from: Accessed on March 8, 2024.
  4. Szlosarek PW, Creelan BC, Sarkodie T, et al. (2024, February 15). "Pegargiminase Plus First-Line Chemotherapy in Patients With Nonepithelioid Pleural Mesothelioma: The ATOMIC-Meso Randomized Clinical Trial." JAMA Oncology. Retrieved March 8, 2024, from