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Chemotherapy for Mesothelioma

Expert Fact Checked

This page was medically reviewed by James Stevenson, M.D. on March 10, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.

James Stevenson, M.D. Thoracic Medical Oncologist

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Chemotherapy is a common treatment for mesothelioma. Chemotherapy drugs kill cancer cells and prevent them from multiplying. Mesothelioma chemotherapy can be used alone or in combination with surgery. The standard first-line treatment is cisplatin or carboplatin with pemetrexed.


01. How Chemo Treats Mesothelioma

How Chemotherapy Treats Mesothelioma

Chemotherapy uses chemicals to kill cancer cells and prevent them from multiplying. As a result, chemotherapy can shrink tumors and limit new tumor growth.

The treatment cannot cure malignant mesothelioma, but it can be effective when used in a combination treatment plan. Chemotherapy’s ability to limit the spread of mesothelioma may increase patient survival and improve quality of life.

There are two methods of administering chemotherapy: systemic chemotherapy or intracavitary chemotherapy.

What Is Systemic Chemotherapy?

Systemic chemotherapy is given through an IV (intravenously), by injection or in pill form. The chemotherapy then travels throughout the bloodstream.

The chemotherapy drugs reach any part of the body where blood flows. As a result, fast-growing cells, such as cells in hair follicles and healthy blood cells, may die along with cancer cells.

This type of chemotherapy may produce the most treatment side effects.

What Is Intracavitary Chemotherapy?

Intracavitary chemotherapy is often administered during surgery. Doctors inject the chemotherapy directly into the body cavity where tumors have formed. For mesothelioma patients, doctors inject chemotherapy into the peritoneal or pleural cavity.

With direct application, this type of chemotherapy has fewer systemic effects. As a result, intracavitary chemotherapy typically has fewer side effects than systemic chemotherapy. Intracavitary chemotherapy also allows oncologists to use much higher doses of chemotherapy.

Patients may hear the term “hyperthermic” in relation to this form of chemo. Chemotherapy administered during surgery is often heated. Researchers have reported heating chemotherapy may increase its effectiveness.

The most common hyperthermic chemotherapy for mesothelioma is HIPEC. This form of chemotherapy is for patients with peritoneal mesothelioma.

02. When Is Chemotherapy Used?

When Is Chemotherapy Used for Mesothelioma?

Patients may receive chemotherapy before or after other treatments for mesothelioma.

Chemotherapy can be a first-line, second-line or third-line treatment. The terminology is determined by the order it’s given after a mesothelioma diagnosis.

First-Line Chemotherapy Treatment for Mesothelioma

The preferred first-line chemotherapy treatment for mesothelioma is a combination of the drugs:

  • Platinum-based cisplatin or carboplatin
  • Pemetrexed

If patients do not respond to first-line chemotherapy, physicians may try a second-line treatment. These secondary treatments may vary from case to case.

Combining Chemotherapy With Other Mesothelioma Treatments

Chemotherapy is often used as part of a multimodal treatment plan. The therapy may be combined with surgery and/or radiation therapy.

  • When used before surgery, it is neoadjuvant chemotherapy.
  • When used after surgery, it is adjuvant chemotherapy.

Currently, researchers are testing chemo for mesothelioma with other emerging therapies. Chemotherapy has been tested with immunotherapy, tumor treating fields and other experimental treatments. Multimodal treatment with these newer therapies may be suitable for some patients.

03. Receiving Chemotherapy

What Is Receiving Chemotherapy Like?

Each patient’s experience receiving chemotherapy may differ depending on their particular diagnosis and treatment plan. In general, mesothelioma chemo treatments include four distinct steps:

  1. Consultation: Before any mesothelioma chemotherapy treatments begin, you will meet with your doctor and ensure chemotherapy is right for you. Doctors may conduct blood work to determine your eligibility.
  2. Prep Work: Ahead of your first chemotherapy session, doctors may prescribe medications. These can limit side effects and any potential complications during treatment.
  3. Treatment: A nurse may supervise your treatment sessions. Dosages and timing of chemotherapy cycles may differ between patients.
  4. Post-Treatment: Following completion of chemo, you will have an appointment with your doctor to discuss how successful the treatment was.
A Mesothelioma Patient’s Perspective on Chemotherapy Treatment

Jim Dykstra was diagnosed with peritoneal mesothelioma and underwent chemotherapy for his cancer. He encourages those undergoing mesothelioma treatment to have a good sense of humor, trust in their doctors and remember they’re not alone in this fight.

How Is Mesothelioma Chemo Administered to Patients?

Mesothelioma patients receive chemotherapy in cycles. Doctors administer the treatment in this way due to the toxic nature of chemotherapy drugs. Treatment cycles typically last between three and four weeks.

Patients in good health may receive two chemotherapy drugs at once. Those unable to withstand the effects of two drugs may instead receive one.

The most common mesothelioma chemotherapy drugs are pemetrexed and cisplatin.

Patients have a rest period following a cycle. These rests allow healthy cells affected by the chemotherapy drugs to repair themselves.

Am I Eligible for Chemotherapy?

Doctors will determine a patient’s eligibility for chemotherapy based on many factors. For instance, a patient’s stage of mesothelioma and overall health can impact eligibility. Mesothelioma patients in poor health may not be suited to chemotherapy treatment due to the related side effects.

Rapidly Dividing Healthy Cells
  • Hair follicle cells
  • Digestive cells
  • Bone marrow

Because chemotherapy drugs are toxic, they may cause many negative side effects. Chemotherapy drugs impact dividing cells. Rapidly dividing cells, like cancer cells, are most harmed by this treatment. Healthy cells that divide rapidly are also harmed by chemotherapy.

Mesothelioma patients should discuss their chemo eligibility with their doctor.

04. Types of Chemotherapy

Types of Mesothelioma Chemotherapy

Researchers continue to analyze the efficacy of different chemotherapy drugs and applications. When determining chemo options, researchers account for mesothelioma type, cell type, patient characteristics and mesothelioma staging.

Mesothelioma Chemotherapy Drugs

Oncologists will determine what chemotherapy drug is best for the patient. A patient’s medical team considers a variety of factors, including side effects. Additionally, mesothelioma specialists may update the prescribed chemotherapy drugs and dosage if the patient doesn’t respond well to treatment.

Chemo Drugs Used for Mesothelioma

  • Pemetrexed (Alimta®)
  • Cisplatin
  • Carboplatin
  • Gemcitabine (Gemzar®)
  • Vinorelbine (Navelbine®)
  • Epirubicin
  • Doxorubicin
  • Paclitaxel
  • Mitomycin-C
  • Oxaliplatin
  • Irinotecan

Pemetrexed (Alimta®)

Pemetrexed, brand name Alimta®, is one of the most common chemotherapy drugs used to treat mesothelioma. Typically, it’s used in combination with a platinum-based drug, such as cisplatin or carboplatin. Pemetrexed has extended patient life expectancies by up to several months.

Cisplatin

Cisplatin is a platinum-based chemotherapy drug. The drug is commonly used alongside pemetrexed. Researchers have reported this combination treatment can extend average patient survival to 12.8 months. When used alone, average patient survival is 9 months. Patients whose tumors cannot be surgically removed may receive cisplatin.

Carboplatin

Carboplatin is a platinum-based drug. The drug was adapted from cisplatin in the 1980s. Carboplatin typically has fewer side effects than cisplatin and may be a better option for some patients.

Gemcitabine (Gemzar®)

Gemcitabine, brand name Gemzar®, is a less commonly used chemotherapy drug. The drug has been relatively effective in mesothelioma chemotherapy trials. Gemcitabine has been used as a first- or second-line treatment option.

Vinorelbine (Navelbine®)

Vinorelbine, brand name Navelbine®, is a less common chemotherapy drug that treats non-small cell lung cancer. Researchers have found the drug to be somewhat effective in treating mesothelioma. The drug can be a first- or second-line treatment.

Mesothelioma Intraoperative Chemotherapy Types

Mesothelioma researchers continue to study intraoperative chemotherapy. However, two types have shown success, including intrapleural chemotherapy and intraperitoneal chemotherapy.

Intrapleural Chemo vs. Intraperitoneal Chemo
What Is Intrapleural Chemotherapy?

Intrapleural chemotherapy is administered directly into the pleural cavity. Pleural mesothelioma patients receive intrapleural chemotherapy during surgery.

What Is Intraperitoneal Chemotherapy?

Intraperitoneal chemotherapy is administered directly into the peritoneal cavity. Peritoneal mesothelioma patients receive intraperitoneal chemotherapy during surgery.

Intrapleural Chemotherapy

Researchers found intrapleural chemotherapy can be used with a surgical procedure. For mesothelioma patients, the chemotherapy is often combined with extrapleural pneumonectomy or pleurectomy. This may increase the effectiveness of surgery and prevent or delay recurrent mesothelioma.

There have been promising reports of using cisplatin and other drugs in this way. However, intrapleural chemotherapy is not yet widely available for mesothelioma. Select cancer centers with expert mesothelioma surgeons currently offer the treatment.

HITHOC
  • What It Stands for: Hyperthermic Intrathoracic Chemotherapy
  • Description: A form of chemotherapy applied directly to the pleural cavity at a high temperature. HITHOC is often used with cytoreductive surgery (pleurectomy/decortication).
  • Potential Complications: collapsed lung (pneumothorax), pneumonia, heart rhythm abnormalities, impaired wound healing, kidney problems, lymph fluid leaking into the pleural cavity (chylothorax), bleeding, blood clots in the lungs

Intraperitoneal Chemotherapy

The most well-known intraperitoneal chemotherapy is hyperthermic intraperitoneal chemotherapy (HIPEC). This therapy has shown success in treatment plans for peritoneal mesothelioma. HIPEC is typically performed after surgeries such as peritonectomy or cytoreductive surgery.

What Is HIPEC? HIPEC is a heated chemotherapy solution. The solution is usually heated to 104 – 109 degrees and is pumped into the abdominal cavity. The solution circulates for about 90 minutes to kill any cancer cells not removed during surgery.

Potential complications from HIPEC include blood clots, infection and hemorrhage (an instance of serious bleeding).

As a locally administered treatment, HIPEC doesn’t substantially affect other areas of the body. The treatment often has fewer side effects than systemic chemotherapy. Researchers have reported HIPEC can extend life expectancies for some patients.

Other Intraperitoneal Chemotherapy Types

In addition to HIPEC, there are other intraperitoneal chemotherapy options: EPIC, NIPEC and PIPAC/PITAC. Compared to HIPEC, these options are newer and researchers are still testing their efficacy.

EPIC
  • What It Stands for: Early Postoperative Intraperitoneal Chemotherapy
  • Description: A non-heated chemotherapy administered starting one day after cytoreductive surgery. The chemotherapy remains in the peritoneum for 23 hours. This treatment is repeated and typically lasts five to seven days.
  • Potential Complications: low red blood cells, infection, fever, increased white blood cells, difficulty breathing, dehydration, stroke, pleural effusion, low platelets, blood clots in the lungs, bleeding, leaks between repaired tissues
NIPEC
  • What It Stands for: Normothermic Intraperitoneal Chemotherapy
  • Description: A form of chemotherapy kept at room temperature. Doctors circulate the drug throughout the peritoneum. Although EPIC and NIPEC are very similar, the timing of the treatments differs. EPIC occurs closer to the original surgery date. NIPEC typically occurs much later.
  • Potential Complications: infection, allergic reaction, peritoneal effusion, bowel perforation
PIPAC/PITAC
  • What It Stands for: Pressurized Intraperitoneal Aerosol Chemotherapy/Pressurized Intrathoracic Aerosol Chemotherapy
  • Description: Chemotherapy applied via minimally invasive surgery. Doctors administer the chemotherapy drug as an aerosol sprayed into the peritoneal cavity. Doctors may recommend PIPAC/PITAC when surgery and HIPEC are not an option.
  • Potential Complications: abdominal pain, postoperative pain, wound pain, nausea/vomiting, kidney problems, leaks between repaired tissues
05. Chemotherapy Side Effects

Chemotherapy Side Effects

Mesothelioma patients may face many side effects of chemotherapy treatment. Most side effects of systemic chemotherapy subside when treatment ends. However, in some cases, side effects may last for years.

Common Side Effects During and/or After Systemic Chemotherapy

  • Weakened immune system (patients may be more susceptible to infections)
  • Bruising and bleeding more easily
  • Fatigue
  • Hair loss
  • Chemo brain
  • Nausea and vomiting
  • Nerve pain (neuropathy)
  • Trouble breathing
  • Gastrointestinal problems (constipation or diarrhea)
  • Skin rash
  • Mouth sores
  • Pain
  • Loss of appetite

Patients should discuss with their medical team when they experience any side effects. The side effects of mesothelioma chemotherapy are typically mild but may be easily managed.

Below we’ve highlighted some of the most common chemo side effects.

  • Hair loss: Many chemotherapy drugs target fast-growing healthy cells. Because hair follicle cells grow quickly, patients may experience hair loss.
  • Low blood cell counts: Reduced blood cell count lowers the body’s immune response. Lower blood cell counts also reduce the flow of oxygen throughout the body. This may lead to the potential for infection, fatigue, easy bruising and bleeding.
  • Chemo brain: Changes in mental/cognitive abilities before, during or after chemotherapy treatment. Chemo brain may be treated with rehab, exercise or meditation.
  • Nausea/vomiting: As chemotherapy drugs spread through the bloodstream, they can cause nausea and vomiting. Anti-nausea medication is often administered.
  • Mouth sores: Mouth sores are an inflammatory reaction. They can also affect chewing, swallowing and taste. Patients can manage mouth sores with pain medication.

Patients should report chemotherapy side effects to their physicians for many reasons, including:

  1. There may be other chemotherapy drugs with fewer side effects available.
  2. Side effects may offer insight into the efficacy of the chemotherapy.
  3. There may be palliative care options available to help patients manage treatment side effects.

Researchers continue to study the effectiveness of new applications and combinations of chemotherapy drugs in clinical trials. Through trials, researchers hope to increase chemotherapy efficacy while limiting side effects.

In newer studies, researchers have found success in combining chemotherapy and immunotherapy drugs. Surgery with HIPEC has also become a popular treatment for peritoneal mesothelioma.

Mesothelioma cancer patients should discuss all treatment options with their doctors to determine the best course of treatment for their case.

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