01. Mesothelioma Chemotherapy
How Does Chemotherapy Treat Mesothelioma?
Chemotherapy treats mesothelioma by killing cancer cells, which divide and multiply more quickly than most other cells in the body. Chemotherapy drugs damage cells while they divide. As a result, chemotherapy can slow the growth of or kill mesothelioma cancer cells.
Chemotherapy targets cancer cells but can also impact healthy cells. This means it often causes side effects, but it also extends survival for many mesothelioma patients. And mesothelioma researchers continue to look for ways to improve chemotherapy applications.
A mesothelioma treatment plan may include more than one chemotherapy drug. It may also combine chemotherapy with other therapy types, like surgery. Oncologists may use chemotherapy to provide two different types of care:
- Therapeutic care: Therapeutic treatments aim to improve the patient’s health and survival.
- Palliative care: Palliative treatments are intended to manage mesothelioma symptoms and improve the patient’s quality of life.
02. Types of Mesothelioma Chemotherapy
Types of Chemotherapy for Mesothelioma
Chemotherapy drugs come in different types, and doctors may administer them in different ways. Patients may be more familiar with chemotherapy that circulates throughout the body (systemic therapy). Chemotherapy may also be confined to a specific location in the body (local chemotherapy).
Treatment plans may include several types of chemotherapy drugs for malignant mesothelioma. They may also include both systemic and local chemotherapy.
How Is Chemotherapy Given?
Systemic chemotherapy travels through the bloodstream. Side effects may occur throughout the body. Mesothelioma patients may receive systemic chemotherapy through intravenous (IV) infusion. Early studies suggest oral chemotherapy medication may also have uses for treating mesothelioma.
Local, or intracavitary, chemotherapy is applied only to a specific region of the body. This targeted application means it may have fewer side effects than systemic chemotherapy. Keeping the chemotherapy drugs in one area generally involves a surgical procedure. As such, doctors may also refer to these treatments as intraoperative chemotherapy.
Types of Local Chemotherapy for Mesothelioma
In general, localized intracavitary chemotherapy methods available to mesothelioma patients depend on tumor location. They may also vary by the temperature of the drugs and the type of drugs used. Common types of local chemotherapy for mesothelioma include hyperthermic intraperitoneal chemotherapy (HIPEC) and hyperthermic intrathoracic chemotherapy (HITHOC).
- HIPEC: This is a heated chemotherapy administered within the peritoneal (lower abdomen) cavity. Peritoneal mesothelioma patients may receive this as part of their treatment plan.
- HITHOC: This is a heated chemotherapy administered within the thoracic (chest) cavity. Pleural mesothelioma patients may receive this as part of their treatment plan.
Mesothelioma treatment plans that include HIPEC or HITHOC have helped extend survival for many patients.
HIPEC for Peritoneal Mesothelioma
Doctors may apply HIPEC to the abdominal cavity to treat peritoneal mesothelioma. In general, they combine HIPEC with a surgery to remove cancer from the abdomen, called cytoreductive surgery (CRS). Doctors use HIPEC to kill cancer cells left behind after performing CRS.
HIPEC after surgery is considered the gold standard in treating peritoneal mesothelioma. Multiple studies have reported long-term survival of patients who received this treatment.
Did You Know?
HITHOC for Pleural Mesothelioma
Doctors may apply HITHOC to the thoracic cavity to treat pleural mesothelioma. In general, they combine HITHOC with surgery for more effective treatment. For example, HITHOC may be administered after:
- Pleurectomy/decortication (P/D): A surgery that removes the lining around the lung (the pleura)
- Extrapleural pneumonectomy (EPP): A surgery that removes the pleura and the affected lung
Doctors use HITHOC to kill cancer cells left behind after performing surgery. Several studies have reported extended survival in patients who received HITHOC plus surgery.
Other Types of Local Chemotherapy for Mesothelioma
Doctors may also recommend other types of local intracavitary chemotherapy for mesothelioma. They can explain eligibility requirements and potential risks and benefits.
Researchers continue to test new applications of chemotherapy in mesothelioma clinical trials.
- Meaning: Early postoperative intraperitoneal chemotherapy (EPIC)
- Timing: After CRS
- Treats: Peritoneal mesothelioma
Resources for Mesothelioma Patients
03. Chemotherapy Drugs
Mesothelioma Chemotherapy Drugs
Doctors may use a number of different chemotherapy drugs to treat mesothelioma. The U.S. Food and Drug Administration (FDA) has approved Alimta® (pemetrexed) plus cisplatin to treat pleural mesothelioma. Studies have tested other chemotherapy drugs to explore their potential mesothelioma treatment applications.
Researchers have looked into using systemic Alimta + cisplatin to treat peritoneal mesothelioma. They found it may extend survival for some peritoneal mesothelioma patients. But CRS and HIPEC extend survival further.
Chemotherapy drugs that may be used to treat mesothelioma include:
- Alimta® (pemetrexed)
- Eloxatin® (oxaliplatin)
- Mitomycin C
- Navelbine® (vinorelbine)
- Paraplatin® (carboplatin)
Although similar, there are slight differences in how each chemotherapy drug works. As a result, they have their own potential benefits and side effects. Oncologists can recommend appropriate chemotherapy drugs and other mesothelioma cancer drugs based on individual patient cases.
Pemetrexed is a common chemotherapy drug for mesothelioma. Mesothelioma patients may be given the brands Alimta® or Pemfexy®. Pemetrexed is FDA-approved for pleural mesothelioma in combination with cisplatin. Doctors may also combine pemetrexed with carboplatin. Some studies and clinical trials found Alimta and cisplatin extended pleural mesothelioma patient survival to about 12 to 15 months.
Cisplatin is a common, platinum-based mesothelioma chemotherapy drug. Patients whose tumors cannot be surgically removed may receive cisplatin. In combination with Alimta, cisplatin is FDA-approved to treat pleural mesothelioma. In studies, patient survival with this combination was between 12 and 15 months.
Carboplatin is a platinum-based chemotherapy drug similar to cisplatin. It may also be referred to by its brand name, Paraplatin. Carboplatin may be a gentler option than cisplatin, with fewer side effects. In a study, pleural mesothelioma patients treated with Alimta and carboplatin had a median survival of about 13 months.
Other Chemotherapy Drugs for Mesothelioma
In some cases, doctors may recommend chemotherapy drugs other than Alimta, cisplatin and carboplatin. These are less common but may be appropriate for some mesothelioma patients. Patients can discuss chemotherapy drug questions with their healthcare team.
Other chemotherapy drugs have sometimes been used to treat mesothelioma. These drugs include doxorubicin, Eloxatin and paclitaxel. Patients can discuss chemotherapy drug questions with their care teams.
04. Chemotherapy in Treatment Plans
Chemotherapy in Malignant Mesothelioma Treatment Plans
Mesothelioma patients may receive chemotherapy alone or in combination with other treatments. Plans involving two or more methods are called multimodal treatment plans. Doctors create personalized plans for patients based on their diagnosis and other factors like patient health.
The timing of chemo in relation to other treatments may differ between multimodal plans. Patients receiving multimodal treatment may hear different terms about the timing of their therapies. These terms relate to the different purposes of each therapy in the overall treatment plan.
Timing of Chemotherapy Treatment for Mesothelioma Patients
- Neoadjuvant chemotherapy: Neoadjuvant therapy occurs before the main cancer treatment.
- First-line chemotherapy: First-line treatment is the first therapy used to treat cancer.
- Adjuvant chemotherapy: Adjuvant therapy occurs after the main cancer treatment. For example, patients may receive maintenance chemotherapy to sustain the beneficial effects of prior therapy.
- Second-line chemotherapy: Second-line treatment is any therapy given when a first-line treatment stops working or the cancer returns.
Combining Chemotherapy With Other Mesothelioma Treatments
A notable multimodal study used repeated rounds of CRS and HIPEC to treat peritoneal mesothelioma patients. This combination of surgery and chemotherapy extended patient survival from 27.2 months to 80 months.
Patients may also receive chemotherapy after treatment with checkpoint inhibitors. Checkpoint inhibitors are a type of immunotherapy that help a patient’s immune system to fight cancer. The FDA has approved a combination of two checkpoint inhibitors, Opdivo® (nivolumab) and Yervoy® (ipilimumab), to treat pleural mesothelioma.
TTFields With Chemotherapy for Pleural Mesothelioma
TTFields are a newer treatment option for mesothelioma patients. By using low-intensity electrical currents, TTFields may slow or stop cancer growth. The FDA approved using TTFields in combination with pemetrexed and platinum-based chemotherapy to treat cancer.
One study on TTFields combined it with chemotherapy to treat pleural mesothelioma patients. Researchers found a 1-year survival rate of 62% and a 2-year survival rate of 42%. Follow-up CT scans showed tumors shrank or stopped growing in 97% of patients.
A patient’s mesothelioma doctor can recommend a custom-tailored treatment plan. This may include one treatment method or a combination of different methods. Factors such as overall health, mesothelioma stage and type may impact treatment options.
05. What to Expect
What to Expect When Receiving Mesothelioma Chemotherapy
Each patient’s experience with mesothelioma chemotherapy may be slightly different. But individuals can keep in mind some general expectations about common practices, procedures and side effects. Patients can speak with their care teams about the details of their specific plans.
A patient’s care team can explain the mesothelioma chemo process for local or systemic methods. They can also answer questions about how to prepare for the appointment. These specifics may vary depending on treatment details, such as which drug is given and how.
For patients receiving systemic chemotherapy, the process may be like the one below.
Sample Systemic Chemotherapy Procedure: Alimta + Cisplatin
- The week before treatment, patients take five daily doses of folic acid.
- Patients also receive one intramuscular injection of vitamin B12 during this time.
- Patients may receive a corticosteroid before, during and after treatment.
- Alimta + cisplatin is administered in 21-day cycles via IV infusion.
- Patients will receive an Alimta infusion, then cisplatin 30 minutes later.
- A doctor will determine the appropriate dosage of each drug.
- Patients generally rest and recover for the rest of the 21-day cycle.
- Patients may undergo multiple cycles.
Side effects can vary from patient to patient. A patient’s care team can help them understand possible side effects and what to expect.
Some common side effects, such as nausea and vomiting, may affect patients’ mental health. Patients can find support from their care team for these challenges as well. Many cancer centers offer dedicated support services for emotional and mental well-being, like support groups.
How Many Chemo Treatments Are Needed for Mesothelioma?
The number of mesothelioma chemotherapy treatment cycles varies by patient. It depends on the patient’s case and other parts of their treatment plan.
Doctors may recommend multiple chemotherapy cycles, if appropriate for patients. For example, some mesothelioma patients have received six cycles or more of Alimta and cisplatin.
Patients can speak with their care team to understand what their experience may be like. This may help patients and their teams better navigate the treatment.
06. Chemotherapy and Prognosis
How Effective Is Chemotherapy for Mesothelioma?
For some patients, chemotherapy may extend mesothelioma life expectancy. In general, malignant mesothelioma survival after chemotherapy ranges from one to five years. Various factors can impact a patient’s mesothelioma prognosis. These factors include chemotherapy method, tumor location and any other treatments.
Several studies have reported the effects of chemotherapy on mesothelioma survival.
- Type of mesothelioma treated: Peritoneal
- Treatment timing: First-line
- Median survival: 4.2 years
- Type of mesothelioma treated: Pleural
- Treatment timing: First-line
- Median survival: 25 months
- Type of mesothelioma treated: Pleural
- Treatment timing: First-line
- Median survival: 12.1 months
A mesothelioma doctor can explain what a patient can expect for their individual case.
Can Chemotherapy Cure Mesothelioma?
Although chemotherapy cannot cure malignant mesothelioma, it may provide important benefits to patients. For some patients, chemotherapy may ease cancer symptoms and improve their quality of life. It may also extend survival in some cases.
Oncologists sometimes use chemotherapy in combination treatment plans. Research suggests combination plans may be more effective than single therapies at extending survival. Some experts say multimodal treatment is the best chance for a mesothelioma cure.
Researchers continue to look for more effective treatment options in mesothelioma clinical trials.
Chemotherapy Clinical Trials
Mesothelioma researchers continue to use clinical trials to study ways to improve chemotherapy’s effectiveness. Many ongoing clinical trials incorporate immunotherapy. Immunotherapy has improved life expectancy and helped manage side effects in mesothelioma patients.
Examples of ongoing mesothelioma chemotherapy clinical trials include:
- Chemotherapy plus atezolizumab: This study incorporates gemcitabine with the checkpoint inhibitor atezolizumab. Checkpoint inhibitors equip the immune system to fight cancer. Atezolizumab is already approved by the FDA to treat non-small cell lung cancer and several other types of cancer.
- Chemotherapy plus toripalimab: This study incorporates treatment with Alimta, carboplatin and a checkpoint inhibitor called toripalimab.
- HIPEC and CRS plus cancer vaccine: This study incorporates a cancer vaccine into a treatment plan involving CRS and HIPEC. Cancer vaccines are a type of immunotherapy. Other clinical trials have also tested different mesothelioma vaccines in patients who received chemotherapy.
- PIPAC plus systemic chemotherapy: This study incorporates localized PIPAC with systemic chemotherapy.
Some of these clinical trials are being conducted outside the United States. American patients may not be eligible to participate in those trials. But results can still provide valuable information for the mesothelioma community. American patients can ask their doctors if they are eligible for United States trials.
07. Mesothelioma Chemotherapy Side Effects
What Are the Side Effects of Chemotherapy for Mesothelioma?
A mesothelioma chemotherapy regimen may lead to a variety of side effects. These can vary based on the type of chemotherapy drugs used. Systemic and intracavitary mesothelioma may also have different side effects. Some mesothelioma chemotherapy side effects are more common than others.
For example, patients may experience cognitive problems both during and after chemotherapy. These cognitive problems, also called chemo brain, include memory issues and trouble concentrating.
Side Effects of Systemic Chemotherapy for Mesothelioma
- Body aches and pains
- Bruising and bleeding more easily
- Chemo brain
- Gastrointestinal problems (constipation or diarrhea)
- Hair loss
- Mouth sores
- Nausea and vomiting
- Nerve pain (neuropathy)
- Skin rash
- Trouble breathing
- Weakened immune system (may be more susceptible to infections)
There may be other side effects associated with intracavitary chemotherapy. These side effects vary across the different types of intracavitary chemo.
Patients should discuss any side effects with their doctors. This includes new side effects or changes to existing treatment side effects. There may be ways to help manage these discomforts during treatment. In other cases, doctors may pause or end treatment. Care teams can also support patients if their mental health suffers during this time.
Who Is Eligible for Mesothelioma Chemotherapy?
The eligibility criteria for mesothelioma chemotherapy are specific. These criteria vary for systemic chemotherapy and intracavitary chemotherapy. Doctors can explain these options further. They can also recommend which, if any, may be appropriate for their patients.
In general, patients with inoperable pleural mesothelioma may be eligible for systemic chemotherapy. Patients with other forms of inoperable mesothelioma may also be eligible.
Patients with operable pleural or peritoneal mesothelioma may be eligible for intracavitary chemotherapy. For these patients, doctors may use a form of local chemotherapy before or after surgery. Depending on various factors, the appropriate chemotherapy could be HIPEC, HITHOC or PIPAC.
Chemotherapy may not be the right option for some patients. If so, their doctors can recommend other treatment options that may work better.
09. Common Questions
Common Questions About Mesothelioma Chemotherapy
How long is chemotherapy for mesothelioma?
- The length of mesothelioma chemotherapy treatment varies based on each patient’s case. In general, systemic infusions occur in cycles as recommended by a doctor. Typically, each cycle lasts for a few weeks. For example, the typical Alimta (pemetrexed) and cisplatin treatment has 21-day cycles.
What type of chemotherapy is used for mesothelioma?
- Standard chemotherapy for mesothelioma consists of Alimta with cisplatin or carboplatin. This combination has a strong history of extending survival. Chemotherapy may be administered throughout the bloodstream or locally in a specific region of the body.
What is the best chemotherapy for mesothelioma?
- Alimta with cisplatin or carboplatin is the standard systemic chemotherapy for pleural mesothelioma. Doctors may add Avastin® (bevacizumab) to this combo. In studies, patients treated with Alimta + cisplatin lived 12 to 16 months after treatment. Adding Avastin extended survival to about 19 months. Additional chemotherapy drugs may be used to boost survival. Studies have reported median survivals of five years or more for peritoneal mesothelioma patients treated with CRS and HIPEC.
How much does mesothelioma chemotherapy cost?
- In a 2019 study, six cycles of Alimta and cisplatin chemotherapy treatment cost an average of $38,779 for an average-size male patient. Insurance may cover a large portion of this, but patients are often left with some out-of-pocket costs. Hiring a lawyer to pursue a mesothelioma lawsuit may lead to compensation that can help pay chemotherapy costs.