Types of Chemotherapy for Mesothelioma

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Treating Mesothelioma with Chemotherapy

Chemotherapy is usually the first line of treatment for all mesothelioma patients. Regardless of mesothelioma stage or type, nearly all patients can receive this chemotherapy treatment.

Types of chemotherapy for mesothelioma may be categorized by their delivery method and how they are used to make surgery more effective.

Types of chemotherapy for mesothelioma include:

• Systemic chemotherapy. Chemotherapy drugs are given by injection or intravenous drip. This is the most traditional type of chemotherapy.
• Intracavitary chemotherapy. Special catheters are placed directly where the mesothelioma tumors are located. This helps deliver chemotherapy directly to the source with the intention of making chemo more effective.
• Multimodal chemotherapy. Multimodal refers to a combination of therapies. For example, many patients receive chemotherapy to make surgery more successful. Chemotherapy can make tumors easier to remove or help kill cancerous cells left behind from surgery.
• First and second-line systemic chemotherapy. Doctors use chemotherapy as first and second-line treatment in advanced mesothelioma. Because patients can develop a tolerance to some drugs, oncologists use different drugs for second-line therapy.

Each type of chemotherapy has different benefits. Your individual diagnosis helps determine the appropriate type of chemotherapy for you.

For example, some patients who are candidates for mesothelioma surgery may benefit most from multimodal chemotherapy. Patients in later stages may benefit more from systemic chemotherapy only.

Peritoneal mesothelioma patients often undergo a combination of surgery and heated chemotherapy called cytoreduction with HIPEC to try and improve their life expectancy by several years.

For veterans who are considering chemotherapy treatments following a mesothelioma diagnosis, additional benefits may be available. Request our free Veterans Packet today to learn more.

Systemic Chemotherapy

Systemic chemotherapy involves delivering chemotherapy via the bloodstream. This is the most common chemotherapy delivery method for all types of cancer.

There are 3 ways to deliver systemic chemotherapy into the bloodstream:

• Simple intravenous (IV) drip. This method uses a tube inserted into the vein in your arm or hand to deliver the drugs. Repeatedly inserting tubes into the veins of your arm and hands causes damage and scarring to the veins over time.
• Central line. This is a long tube placed inside the large vein in your chest. The tube is also called a central venous catheter (CVC). Doctors use local anesthesia to insert this thin catheter. The line stays in until your chemotherapy cycles are complete. The central line is clamped and sealed with a special cap when not in use.
• PICC line. Like a central line, a PICC line also uses a long, thin tube to deliver chemo. PICC stands for “peripherally inserted central catheter.” A PICC line may also stay in place until you have completed your cycles of chemotherapy. It is placed in the vein above your elbow without requiring anesthesia. The line is guided through the vein until it reaches the large vein in your chest.

The systemic delivery method you receive depends on the chemotherapy drugs your doctor has prescribed. It also depends on the dose and how long it takes to receive the drugs. Some drugs can be delivered in under 15 minutes, while others take hours to administer.

Patients receiving many rounds of chemotherapy are more likely to have a central or PICC line put in place. This makes it easier for patients and doctors because a new tube doesn’t have to be inserted at each visit.

Central and PICC lines are usually better for patients whose veins can’t handle frequent tube insertion. These lines also minimize the risk of chemotherapy drugs leaking into the surrounding tissue compared to a regular IV.

If you receive a central line or PICC line, always remember:

• Keep the area around the insertion site clean.
• Wash your hands before touching the insertion site.
• Tape the tubes to your body to prevent creasing.
• Keep the bandages over the site dry.

Types of Multimodality Chemotherapy Treatments

Multimodal treatment is commonplace for mesothelioma patients. This is when a patient receives 2 or more treatment modalities, such as chemotherapy and radiation. Surgery and chemotherapy are popular multimodal methods due to their success rates.

Surgical treatment offers the best chances of survival for eligible patients. Studies have also shown that multimodal treatment increases survival times even more.

A common trimodality therapy is chemotherapy treatment first, surgery second, and radiation therapy as the third form of treatment. According to some studies, patients who receive this type of treatment can double their survival time.

Chemotherapy types can vary when the patient receives the drug in relation to surgery. Chemotherapy may be administered before, during, or after a surgical operation.

Each method has risks and benefits. The type that’s right for you depends on your diagnosis. The stage of your disease, cell type, and overall health are only some of the factors that mesothelioma specialists consider before prescribing chemotherapy.

Below are the 3 different time frames when chemotherapy may be given in relation to surgery.

Neoadjuvant Chemotherapy

Many surgical candidates receive intravenous chemotherapy before surgery, known as neoadjuvant chemotherapy. It’s used in pleural and peritoneal mesothelioma patients.

The purpose of neoadjuvant therapy is to make surgery more successful.

Mesothelioma tumors are small and dispersed in the chest or abdominal cavity. Shrinking these tumors into smaller areas offers surgeons a better margin of success. This is because surgeons can cut away a greater portion of tissue with the hope of removing a larger portion of the patient’s mesothelioma.

In a study of neoadjuvant chemotherapy followed by surgery and radiation therapy, the median survival time was 25.5 months.

Intraoperative Chemotherapy

Some surgeons administer chemotherapy during surgery, which is called intracavitary chemotherapy.

In one review of intraoperative mesothelioma treatments, the authors said, “The advantage of the [intraoperative chemotherapy] is that local effects can be enhanced whereas systemic side effects of the therapeutic agents applied might be reduced.”

The primary benefit of intraoperative chemotherapy is survival time. Patients who receive intrapleural chemotherapy in addition to surgery have a median survival of about 35 months or 3 years.

Peritoneal mesothelioma patients have even better outcomes from intraoperative chemotherapy. Studies have published survival times greater than 4 or 5 years.

An additional benefit of intraoperative chemotherapy is reduced side effects. Unlike systemic chemotherapy, intraoperative chemo isn’t introduced directly into the bloodstream.

Doctors place chemotherapy directly into the chest or abdomen for a short period of time. The chemotherapy doesn’t have time to circulate through the body, causing unwanted effects.

Adjuvant Chemotherapy

Adjuvant therapy is chemotherapy given intravenously following surgery. Surgeons aren’t able to remove all the microscopic cancer cells during surgery. Since there are lingering mesothelioma cells in the body, adjuvant chemotherapy may help to kill the remaining cells.

If you plan on meeting with an oncologist or surgeon to discuss your illness, request our free guide to 14 questions you should ask your mesothelioma specialist.

First and Second-Line Systemic Chemotherapy

Most patients receive a combination of pemetrexed (brand name Alimta^(R)) and cisplatin as their first line of advanced mesothelioma treatment. This combination was standardized after a landmark 2003 study showed superior survival times for patients who received both drugs.

First-line chemotherapy itself hasn’t changed much since 2003.

“The combination of cisplatin and pemetrexed has become standard first-line therapy worldwide for patients who are not suitable for aggressive surgery, or in whom chemotherapy is recommended as part of a multimodality regimen.”

— Dr. Anna Nowak, mesothelioma doctor

Second-line chemotherapy takes place when a patient’s disease comes back.

Most people with mesothelioma experience a recurrence of their disease. Their first-line treatment slowed or reversed the disease progression, but eventually, the disease returned. Second-line chemotherapy can prolong survival times.

Second-line chemotherapy is still in development. Doctors may use any combination of different chemotherapy drugs, or they may continue with pemetrexed and cisplatin. If you are looking for second-line treatment, clinical trials may offer the solutions you’re looking for.

Which Type of Chemotherapy Is Right for You?

The nature of mesothelioma treatment is based on specialization, which is why several types of mesothelioma chemotherapy exist. Each patient has different needs, and researchers haven’t found one all-encompassing treatment.

The main uses of chemotherapy include:

• Systemic chemotherapy for surgical (neoadjuvant and adjuvant) and non-surgical candidates
• Intraoperative chemotherapy
• Chemotherapy for pain relief in advanced stages

Your doctor will help you choose the chemotherapy type that fits your specific diagnosis and stage. If you’re unhappy with the course of treatment your doctor has chosen, consider getting a second opinion.

Our VA claims agents are familiar with mesothelioma treatment and have connections to specialists who can help. Call us today at (877) 450-8973 to get started.