How Chemotherapy Treats Mesothelioma
Chemotherapy (chemo) is often used to treat mesothelioma, according to the American Society of Clinical Oncology (ASCO).
The main purpose of chemotherapy for mesothelioma is to help the patient live longer. These anti-cancer drugs target and destroy mesothelioma cells. In the process, they can also ease symptoms by shrinking cancer tumors.
If the mesothelioma patient’s cancer is widespread at the time of diagnosis, doctors may use chemo for palliative care, which aims to ease painful symptoms and improve quality of life.
If you or a loved one has been diagnosed with mesothelioma, chemotherapy will likely be a part of the treatment regimen that doctors will use to help you.
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Chemotherapy Drugs for Mesothelioma
Doctors use a variety of chemotherapy drugs to help patients. The most commonly used mesothelioma chemotherapy drugs are cisplatin and pemetrexed.
Cisplatin and Pemetrexed
The combination of cisplatin and pemetrexed (Alimta®) was approved to treat mesothelioma among patients by the U.S. Food and Drug Administration (FDA) in 2004.
- Cisplatin is a platinum-based drug that ‘programs’ cancer cells to die when interacting with DNA
- Pemetrexed works by preventing cancer cells from dividing and spreading
This combination is frequently used as a first-line treatment for mesothelioma patients, meaning it is often the initial therapy they receive following a diagnosis.
If a patient cannot tolerate cisplatin, doctors can replace it with carboplatin, another platinum-based chemotherapy drug. Carboplatin was approved for use in treating mesothelioma by the FDA in 2008.
If cisplatin and pemetrexed aren’t helping a mesothelioma patient, doctors can prescribe gemcitabine (Gemzar®). This drug prevents the mesothelioma cells from spreading as quickly.
Gemcitabine was initially developed for lung and breast cancers. However, doctors also use it to improve life expectancy in advanced-stage mesothelioma patients.
A 2022 report from the Journal of Clinical Medicine noted that gemcitabine can be substituted for pemetrexed and used alongside cisplatin to help patients.
Other Chemotherapy Drugs
Depending on your health, the type and stage of your mesothelioma, and other factors, doctors may prescribe other chemotherapy drugs for mesothelioma.
Commonly used chemotherapy drugs include:
- Doxorubicin (Adriamycin®)
- Ranpirnase (Onconase)
- Vinorelbine (Navelbine®)
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How Is Mesothelioma Chemotherapy Administered?
Doctors usually administer mesothelioma chemotherapy in one of two ways, according to the American Cancer Society (ACS).
These ways include:
- Intraoperative chemotherapy: This is done after surgery when the incision site is still open. The care team releases a chemotherapy drug directly into the abdomen or chest cavity after the surgeons have removed all visible cancer tumors. These types of chemotherapy drugs are often warmed up to improve their effectiveness.
- Systemic chemotherapy: This involves giving a patient chemotherapy drugs through a needle or port into a vein. The drugs then enter the bloodstream to destroy mesothelioma cells throughout the body.
Doctors will typically give chemotherapy in cycles. This means that the patient will be receiving the drugs for a set period of time, and then be taken off them to let the body rest. This is because chemotherapy kills both cancerous and noncancerous cells, so it can be taxing on the patient.
Chemotherapy in Multimodal Mesothelioma Treatment
Multimodal mesothelioma treatment combines more than one type of therapy to help patients. It is also called multimodality therapy and combination therapy.
Many doctors use chemotherapy in multimodal treatment plans that include surgery, radiation therapy, and immunotherapy. Doctors often use surgery and chemotherapy together to treat patients.
Doctors may use mesothelioma chemotherapy:
- Before surgery: The cancer care team can use chemotherapy before surgery to kill mesothelioma cells and shrink tumors, which can improve surgical success. This is called neoadjuvant or preoperative therapy.
- During surgery: Doctors may provide chemotherapy while a surgery is ongoing to provide a concentrated dose to the cancerous area.
- After surgery: Surgeons try to remove as much cancerous tissue as possible, but they often leave some cells behind. The team can use chemotherapy after surgery — known as postoperative or adjuvant therapy — to kill the remaining cancerous cells.
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Chemotherapy for Different Types of Mesothelioma
Generally speaking, most doctors use cisplatin and pemetrexed to treat mesothelioma.
However, chemotherapy prescriptions may vary depending on the type of mesothelioma. This cancer can develop in four different parts of the body, which can affect the types of treatments used to help patients.
Chemotherapy for Pleural Mesothelioma
Malignant pleural mesothelioma affects the pleura, the lining of the lungs.
The main chemo drugs used for the treatment of pleural mesothelioma are pemetrexed and cisplatin or carboplatin. If the cancer returns, doctors may prescribe gemcitabine or vinorelbine.
In a 2023, review of treatment plans for over 40,000 pleural mesothelioma patients from the journal Cancer Medicine, over 50% received chemotherapy, making it the most commonly used treatment for this cancer.
Systemic chemotherapy is common for pleural mesothelioma.
However, one emerging pleural mesothelioma chemotherapy treatment is heated intrathoracic chemotherapy (HITOC or HITHOC). During this treatment, doctors will bathe the pleura (lung lining) in warmed-up chemotherapy medications to kill any remaining mesothelioma cells after surgery.
Oncology (cancer) doctors typically use chemotherapy for early-stage pleural mesothelioma, alongside radiation therapy and surgery.
Chemotherapy for Peritoneal Mesothelioma
Malignant peritoneal mesothelioma begins in the peritoneum, the lining of the abdominal cavity.
The most commonly used peritoneal mesothelioma chemotherapy drugs include cisplatin and pemetrexed. Doctors may also use gemcitabine, vinorelbine, and carboplatin if the first-line drugs don’t work.
Peritoneal mesothelioma is usually treated with hyperthermic intraperitoneal chemotherapy (HIPEC). This involves first removing cancer from the peritoneum through cytoreductive surgery and then bathing the abdominal cavity in heated chemotherapy drugs.
Your care team may also give chemotherapy for peritoneal mesothelioma through a vein. If you are otherwise healthy and have early-stage peritoneal mesothelioma, you may receive chemotherapy directly into your abdomen.
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Chemotherapy for Pericardial Mesothelioma
Pericardial mesothelioma is a rare type of this cancer that affects the pericardium, the membrane of the heart.
In a report from the medical journal Clinical Lung Cancer, pericardial mesothelioma patients who received chemotherapy lived for 18 months on average. Those who didn’t receive chemo lived for an average of two weeks.
Chemotherapy for Testicular Mesothelioma
Testicular mesothelioma forms in the lining of the testicles, and it is the rarest form of this cancer.
The main chemotherapy treatment for testicular mesothelioma is adjuvant therapy with pemetrexed and cisplatin. It is typically administered after an orchiectomy, which is a surgery that involves removing one or both testicles.
Preparing for a Mesothelioma Chemotherapy Session
Because mesothelioma chemo drugs are so strong, patients must prepare for chemotherapy sessions.
Here are some ways to prepare for chemotherapy:
- Ask about fertility: Some chemotherapy methods can affect male and female fertility. Talk to your specialist to learn about your options.
- Arrange for a driver: You may be able to drive after receiving chemo, but someone should drive you on the first day. You may need a driver for follow-up appointments if you aren’t feeling well.
- Find help with kids: If you have children, you may need to ask someone to look after them when you receive treatment.
- Research chemo access points: If you are receiving systemic chemo, you may have a catheter, port, or pump surgically implanted. This can reduce needle insertions when receiving chemo cycles.
- Stay as healthy as possible: Chemo can be hard on the body. As such, you should try to stay as healthy as possible before and during treatment. Hydrate frequently, eat nourishing food, get enough sleep, exercise frequently, and get enough rest.
- Take necessary supplements: Certain chemo drugs, such as pemetrexed, can lower levels of vitamin B12 and folic acid in the body. As such, you may need to take daily doses of folic acid and vitamins to avoid certain side effects. Always check with your doctor ahead of time before taking a supplement.
- Talk to your employer: If you work, tell your employer how much time you need off in advance. Determining how chemotherapy will affect you can be difficult, so you should ask for flexible hours or take a leave.
- Visit the dentist: You may need to see a dentist to ensure you have no mouth infections. Once you start chemotherapy, it will be more difficult to fight off infection.
The best way to prepare for chemotherapy varies depending on your symptoms and medical history. Learn more about chemo preparation by talking with your doctor.
What Happens During Mesothelioma Chemotherapy?
If your oncology care team has recommended chemotherapy for malignant mesothelioma, here’s what you can expect.
1. Develop Your Treatment Regimen
First, you will meet with your cancer care team, who will develop a personalized mesothelioma treatment plan based on your individual goals and needs.
You will have to take blood tests to ensure that you are healthy enough to receive chemotherapy drugs. Your team may also order blood, kidney, liver, and heart tests.
After these test results, doctors can then create a chemotherapy regimen if they believe this treatment will help you.
A regimen will outline:
- Which chemotherapy drug(s) you’ll receive
- How much you’ll receive (dosages and cycle schedule)
- How you’ll receive it (systemic before or after other treatments or intraoperative)
- Which other mesothelioma treatments you’ll undergo
2. Receive Chemotherapy
Once your team has finished creating the regimen, they will start administering treatments. When and how you receive chemotherapy depends on your treatment plan.
- If you’re receiving systemic chemotherapy, you’ll get an infusion into a vein through a needle. The care team can also give you the drugs by inserting a tube into a device in a vein in your abdominal or chest cavity.
- If you’re undergoing intraoperative chemotherapy, you’ll receive treatments during or shortly after a mesothelioma surgery.
Depending on which treatment your doctors choose for you, a chemotherapy session can last from a few minutes to hours.
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3. Undergo Continued Chemotherapy Infusions
If you and your care team chose systemic chemotherapy, you’ll probably get treated in cycles over 3-4 weeks, according to the ACS.
Your medical team will give you rest periods in between these cycles to let your body recover from cancer treatment.
4. Get Follow-Up Care
Once you are done with a chemotherapy regimen, you will attend follow-up visits with the care team. During these visits, you can ask questions and discuss whether you need more chemo cycles.
Side Effects of Chemotherapy for Mesothelioma
Some people may experience side effects when taking chemotherapy for mesothelioma since the treatment harms both healthy cells and cancer cells.
Common side effects of chemotherapy for mesothelioma include:
- Constipation and diarrhea
- Hair loss
- Loss of appetite
- Unintended weight loss
- Weakened immune system
If you’re experiencing concerning or severe side effects from chemotherapy, make sure to reach out to your cancer doctor.
How Mesothelioma Chemotherapy Affects Life Expectancy
Chemotherapy has a large impact on mesothelioma life expectancy since it shrinks tumors and kills cancer cells.
According to the 2023, Cancer Medicine report, pleural mesothelioma patients treated with chemotherapy lived for 14 months on average. Those who didn’t get mesothelioma chemotherapy lived for just 6 months.
Peritoneal patients who undergo a cytoreduction surgery with HIPEC typically live 53 months, according to a study published in the medical journal Translational Lung Cancer Research in 2020. This is a significant improvement compared to the overall survival of 6-12 months of those who do not receive treatment.
Does Chemotherapy Affect Mesothelioma Survival Rates?
The mesothelioma survival rate is the percentage of patients living at a given time after diagnosis. Mesothelioma chemotherapy can increase survival rates, especially if it is part of a multimodal treatment approach.
According to a 2019 Cancer Management and Research study, peritoneal mesothelioma patients who receive HIPEC and cytoreductive surgery have a 5-year median survival rate of 47%.
5-year survival rates were also slightly higher among pleural mesothelioma patients treated with chemotherapy at 8%, compared to those who didn’t at 7% in the 2023, Cancer Medicine study.
New Mesothelioma Chemotherapy Drugs & Clinical Trials
Cancer specialists have been researching new mesothelioma chemotherapy drugs to extend the lives and well-being of patients through clinical trials.
Dozens of clinical trials across the United States are looking at how chemotherapy can help patients.
For example, targeted chemotherapy is a newer cancer treatment being tested in these trials. It targets cancer-specific proteins in cells to shrink tumors. One of these drugs includes bevacizumab (Avastin®), which stops a substance called vascular endothelial growth factor (VEGF) from working to starve cancerous tumors.
Doctors can use targeted mesothelioma chemotherapy to destroy cancer cells without hurting healthy ones. As a result, patients will experience fewer chemotherapy symptoms.
If you are interested in joining a clinical trial involving mesothelioma chemotherapy, contact your cancer care team.
Find Chemotherapy Treatment for Mesothelioma Now
Mesothelioma chemotherapy is a cornerstone of treating this cancer. If you’re interested in receiving chemotherapy for mesothelioma — as well as other treatments that can help you — reach out to the Mesothelioma Resource Group now.
Our team has relationships with top mesothelioma doctors and with our help, you may be able to access treatments in less time. We can also help you afford the costs associated with mesothelioma chemotherapy and other treatments.
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Mesothelioma Chemotherapy FAQs
How long is chemotherapy for mesothelioma?
Mesothelioma chemotherapy cycles typically last around 3-4 weeks. However, chemotherapy cycles may vary depending on the patient and individual factors. Patients may need multiple cycles depending on the stage of their diagnosis.
What type of chemotherapy is used for malignant mesothelioma?
The most common mesothelioma chemotherapy regimen is a combination of pemetrexed and cisplatin. That said, each patient’s chemotherapy regimen will vary due to factors like their overall health, cancer stage, cancer type, and more.
How effective is chemotherapy in treating mesothelioma?
Chemotherapy is a very effective mesothelioma treatment. Patients can live for many months or years longer thanks to mesothelioma chemotherapy.
To get a better idea of how mesothelioma chemotherapy will be in your case, talk to a skilled cancer doctor.
Can chemo cure mesothelioma?
No. There’s no cure for mesothelioma at this time. However, chemotherapy can improve the life expectancy and quality of life for many mesothelioma patients by killing cancer cells and reducing mesothelioma symptoms.