Chemotherapy is one of the most widely employed treatments for all types of cancer. Literally meaning “chemical therapy”, chemotherapy was developed in the 1940s. Today, there are more than 100 chemotherapy drugs on the market.
Chemotherapy uses certain medications to kill cancer cells and stop them from multiplying. A number of different chemotherapy drugs are available to treat mesothelioma, although some of these drugs have proven to be more successful than others. Often, chemotherapy is used for mesothelioma patients in conjunction with other standard therapies such as mesothelioma radiation. It may also be used in an adjuvant capacity following surgery to eliminate any tumor that remains after the procedure is complete.
Chemotherapy often represents the most efficacious solution for medical oncologists as they evaluate a patient’s treatment options. Cancer researchers and other doctors continue to apply exploratory chemotherapy drugs in the treatment and management of malignant mesothelioma.
Chemotherapy, over the years, has elicited fear in many patients because this type of treatment can produce unpleasant side effects. It is important, therefore, that those individuals with mesothelioma for whom chemotherapy is recommended for palliative reasons, carefully consider all of the side effects before agreeing to the treatment. The results of weighing the positive and negative factors of the treatment against the impact on overall quality of life will vary from patient to patient; this process is necessary, however, to ensure that the best treatment decision is made.
Chemotherapy is generally given intravenously or it may also be administered in pill form. This type of chemo is called “systemic” chemotherapy—it travels through the blood stream and reaches the entire body. Systemic chemotherapy carries the most side effects because it not only does the job it is meant to do—kill fast-growing cancer cells—but, unfortunately, it also kills other kinds of fast-growing cells such as hair and blood cells. Hence, many people undergoing chemotherapy treatment will lose their hair and suffer low white or red blood cell counts.
Some pleural mesothelioma patients may be candidates for a different kind of chemotherapy that more closely targets the tumor and causes fewer side effects. Known as intrapleural chemotherapy, this method involves infusing drugs via a catheter into the chest area—the site of the primary tumor. This intracavitary chemotherapy treatment has proven to be most successful in treating cancers that are still limited to just the pleural surface. A similar procedure is available for those who suffer from peritoneal mesothelioma.
Common Mesothelioma Cancer Chemo Drugs
A number of different chemotherapy drugs can be used to treat mesothelioma. Currently, the most widely used drug and the one with which doctors have had the most success is Alimta®. This drug is usually used in tandem with a platinum agent like Cisplatin and has been shown to add several months to the patient's mesothelioma life expectancy in many cases.
Alimta is a systemic drug and is injected into the vein. It is normally given once every 21 days. Patients who are prescribed a course of treatment with Alimta will also be expected to take folic acid and Vitamin B12 to lower the chance of developing harmful side effects. This is essential! Patients will also be given a round of corticosteroids, usually for 3 days, in conjunction with each Alimta injection in order to avoid certain adverse skin reactions.
Cisplatin is administered through an IV and is frequently used in combination with other drugs like Alimta. Doctors will treat mesothelioma patients with Cisplatin when surgery is not an option..
Carboplatin was introduced to the market in the late 1980’s and was derived from an older drug known as Cisplatin. It has fewer and milder side effects than Cisplatin but can inhibit the body’s production of blood cells.
Gemcitabine, a chemotherapy drug brought to market by Eli Lilly and Company is often used in combination with Carboplatin. Patients treated with the drug report fewer and milder side effects.
Onconase is a promising new chemotherapy drug for treating mesothelioma that is still being evaluated in clinical trials. One of the key advantages of the drug is that it kills cancer cells while preserving healthy tissue.
Navelbine is often used in combination with Cisplatin in treating mesothelioma. It can be administered orally or through an IV and has been successful in reducing the size of tumors.
Other chemo drugs used to treat mesothelioma patients include vinorelbine, mitomycin and raltitrexed. These are generally used in combinations but may be used alone if the patient is unable to tolerate two drugs.
The recommended chemotherapy drug will vary with each patient. Oncologists choose the drugs they believe will most benefit the patient while also taking into consideration side effects and other important issues surrounding the use of chemotherapy. It may take more than one try to discover which drugs will be best suited to the patient.
Chemo brings with it many side effects though, as previously mentioned, newer drugs prompt fewer negative reactions. Most side effects are short term and will indeed go away shortly after treatment ceases. Others will last a little longer. Nonetheless, any and all side effects should be reported to the patient’s medical team, even if they are deemed “common” side effects of chemotherapy. This is especially important after the first treatment when it is particularly difficult to predict how the patient will react to certain drugs. Prompt treatment of certain side effects may help lessen them or stop them all together.
The most common side effects of mesothelioma-related chemotherapy include:
Chemo Brain - Chemo Brain is a condition that is reported in a large number of patients who receive chemotherapy and other types of cancer treatment. While there is currently no “cure” for chemo brain there are a variety of habits that can be adopted to help manage it.
Hair loss - Loss of hair occurs because hair cells are fast-growing like cancer cells. Chemo drugs are unable to distinguish one from the other and, as a result, these cells suffer death at the hands of the drugs and the patient’s hair falls out.
Mouth sores - Mouth sores - or mucositis - are an inflammatory reaction of the mucous lining of the upper gastrointestinal tract, affecting the mouth, lips, throat and surrounding tissues. These are one of the most painful side effects of chemo and can also interfere with nutrition as the sores make it difficult to chew and swallow and can also affect taste. In general, they cannot be prevented but they can be managed. The patient will need to keep the mouth and lips moist and will want to ask their doctor about ways to treat discomfort and pain associated with mucositis.
Nausea and vomiting - Though newer drugs cause far less nausea than older ones, the patient is generally given an anti-emetic drug before chemo to lessen the chance of stomach distress. Inform your doctor if nausea gets out of hand and lasts more than a day or two, interfering with eating.
Increased chance of infection - This is due to low white blood cell counts. Those undergoing chemotherapy should avoid contact with sick individuals.
Bruising or bleeding - This is due to low platelet counts caused by the drugs.
Fatigue - When the red blood cell count is lowered due to chemo drugs, severe fatigue sets in. Chemo patients should strive to get as much rest as possible.
Ong, ST, Vogelzang, Nicholas J. Chemotherapy in malignant pleural mesothelioma. A review. Journal of Clinical Oncology, 2006. Vol. 14, 1007-1017.
Weder, Walter. Kestenholz, Peter. Taverna, Christian. Neoadjuvant Chemotherapy Followed by Extrapleural Pneumonectomy in Malignant Pleure Mesothelioma. Journal of Clinical Oncology 2004 Vol. 22(17): 3451-3457
Liu, W. Bodle, E. Chen, JY. Tumor necrosis factor-related apoptosis-inducing ligand and chemotherapy cooperatre to induce apoptosis in mesothelioma cell lines. American Journal of Cellular Molecular Biology. 2001. Jul. 25 (1): 111-1118
Rusch, Valerie. Saltz, L. Venkateraman, E. Ginsberg, R. A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. Journal of Clinical Oncology. 1994. Vol. 12: 1156-1163.