01. Mesothelioma Chemotherapy
How Does Chemotherapy Treat Mesothelioma?
Chemotherapy treats mesothelioma by killing cancer cells. Chemotherapy drugs affect cells while they divide. Cancer cells divide and multiply more quickly than most other cells in the body. This means that chemotherapy targets fast-growing cancer cells. As a result, chemotherapy can slow the growth of mesothelioma cancer cells or kill them.
While chemotherapy targets cancer cells, it may also impact other healthy cells. Still, chemo drugs are generally less toxic to healthy cells than to fast-growing cancer cells. Chemotherapy is a part of many mesothelioma treatment plans.
Researchers continue testing different combinations and applications of mesothelioma chemotherapy options. For example, a combination may be one chemotherapy drug combined with another. It may also be chemotherapy combined with a different treatment method, like surgery.
For mesothelioma patients, chemotherapy may provide two types of care:
- Palliative care: Intended to reduce symptoms of mesothelioma and improve the patient’s quality of life
- Therapeutic care: Intended to support the patient’s health and their recovery from mesothelioma
This classification depends on each individual patient’s case and treatment plan. For some mesothelioma patients, chemotherapy may extend survival and improve quality of life.
02. Types of Mesothelioma Chemotherapy
Types of Chemotherapy for Mesothelioma
There are various types of chemotherapy for malignant mesothelioma. Oncologists may administer chemotherapy drugs through differing methods. Patients may be most familiar with traditional systemic chemotherapy. Systemic chemotherapy may be given through an intravenous (IV) infusion, among other methods.
Doctors may also recommend non-systemic treatment called intracavitary chemotherapy. This approach is also called local chemotherapy because it confines the drug to a defined location. These local treatments have names that account for the treatment location:
- Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered within the peritoneal (lower abdomen) cavity.
- Hyperthermic intrathoracic chemotherapy (HITHOC) is administered within the thoracic (chest) cavity.
In studies, this approach has extended survival for pleural and peritoneal mesothelioma patients.
Systemic chemotherapy travels through the bloodstream. Patients may receive it in the form of a pill, injection or IV infusion. Systemic means the treatment reaches all or most parts of the body. As a result, patients may experience treatment side effects throughout their body. Systemic chemotherapy may have more side effects than intracavitary chemotherapy methods.
Intracavitary chemotherapy is a localized treatment. This means it is applied only to a specific region of the body. Keeping the chemotherapy drugs in one area generally involves a minor surgical procedure. As such, doctors may refer to these treatments as intraoperative chemotherapy.
Doctors generally target this treatment according to the tumor location. For pleural mesothelioma, the chemotherapy may go into the thoracic or pleural cavities. The pleural cavity is the space between membranes that surround the lungs. For peritoneal mesothelioma, the chemotherapy goes in the peritoneal cavity.
There are different types of intracavitary chemotherapy. These types vary based on administration method and temperature. For instance, some may be heated while others are not. Methods with success in treating mesothelioma include HIPEC and HITHOC.
HIPEC for Peritoneal Mesothelioma
HIPEC is a form of hot chemotherapy, confined to the abdominal cavity. Thus, doctors may use this method to treat peritoneal mesothelioma. For cancer treatment, HIPEC is generally used along with cytoreductive surgery (CRS) to remove cancerous tumors.
Researchers have found HIPEC improved survival in some peritoneal mesothelioma patients. 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.
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HITHOC for Pleural Mesothelioma
HITHOC is a form of hot chemotherapy, confined to the pleural or thoracic cavities. Thus, doctors may use this method to treat pleural mesothelioma. For cancer treatment, HITHOC is generally used along with surgery.
In studies, HITHOC extended pleural mesothelioma survival to about three years.
Other Types of Intracavitary Chemotherapy for Mesothelioma
Doctors may also recommend other types of intracavitary chemotherapy for mesothelioma. If interested, a patient and their mesothelioma doctor can discuss these options. Their doctor can explain eligibility requirements and potential risks and benefits.
- EPIC stands for early postoperative intraperitoneal chemotherapy.
- This type of chemo is non-heated and administered some time after CRS.
- Doctors may use EPIC to treat peritoneal mesothelioma.
- PIPAC stands for pressurized intraperitoneal aerosol chemotherapy.
- This type of chemo is an aerosol sprayed into the peritoneal cavity.
- Doctors may use PIPAC to treat some cases of peritoneal mesothelioma.
Researchers continue testing new combinations and applications of chemotherapy for mesothelioma in clinical trials.
Resources for Mesothelioma Patients
03. Chemotherapy Drugs
Mesothelioma Chemotherapy Drugs
Mesothelioma chemotherapy generally includes the drugs pemetrexed (Alimta®) and cisplatin. But studies have tested many other chemotherapy drugs for mesothelioma. Doctors can recommend specific drugs based on individual patient cases.
The U.S. Food and Drug Administration (FDA) approved Alimta + cisplatin for the treatment of pleural mesothelioma.
Chemotherapy drugs that may be used for mesothelioma include:
- Gemcitabine (Gemzar®)
- Oxaliplatin (Eloxatin®)
- Pemetrexed (Alimta®)
- Vinorelbine (Navelbine®)
Although similar, there are slight differences in how each chemotherapy drug works. As a result, they all have their own potential benefits and side effects. Doctors may recommend combining chemotherapy drugs with other mesothelioma treatments.
Pemetrexed, brand name Alimta, is a common chemotherapy drug for mesothelioma. It is FDA-approved for pleural mesothelioma in combination with cisplatin. Doctors may also combine Alimta with carboplatin.
Alimta is a systemic chemotherapy, meaning it is intravenously administered. Doctors may recommend repeating the infusion cycles. Some studies and clinical trials found Alimta and cisplatin extended patient survival to about 12 to 15 months.
Cisplatin is a platinum-based chemotherapy drug. In combination with Alimta, cisplatin is FDA-approved to treat pleural mesothelioma. Patients whose tumors cannot be surgically removed may receive cisplatin.
In studies, patient survival with this combination was between 12 and 15 months. When cisplatin was used alone, patients survived about nine months.
Carboplatin is a platinum-based drug and is an adaptation from cisplatin. For some patients, carboplatin may be a gentler option with fewer side effects than cisplatin.
Carboplatin received FDA approval in the 1980s but is not approved for mesothelioma. Still, some mesothelioma patients have been treated with carboplatin. Patients and their doctors can discuss treatment options for their mesothelioma diagnosis. In a study, patients treated with pemetrexed and carboplatin had a median survival of about 13 months.
Other Chemotherapy Drugs for Mesothelioma
In some cases, doctors may recommend administering other chemotherapy drugs for mesothelioma. These are not as common as combinations including Alimta, cisplatin or carboplatin. Still, these alternative chemo drugs may be appropriate for some mesothelioma patients.
Other chemotherapy drugs have sometimes been used to treat mesothelioma. These drugs include doxorubicin, oxaliplatin (Eloxatin®) and paclitaxel.
Patients can discuss chemotherapy drug questions with their care team.
04. Chemotherapy in Treatment Plans
Chemotherapy in Mesothelioma Treatment Plans
Mesothelioma patients may receive chemotherapy alone or in combination with other treatments. Treatment plans involving two or more methods are called multimodal plans. Doctors create personalized plans for patients based on their diagnosis and other factors like patient health.
Patients with multimodal treatment plans involving chemotherapy may hear the following terms:
- Adjuvant chemotherapy: When chemotherapy occurs after the main cancer treatment
- Neoadjuvant chemotherapy: When chemotherapy occurs before the main cancer treatment
The timing of chemo in relation to other treatments may differ between multimodal plans. For example, some mesothelioma patients may receive radiation therapy before or after chemotherapy.
Chemotherapy in Combination With Other Mesothelioma Treatments
Researchers are studying mesothelioma treatments with chemotherapy. A notable study on this subject used repeated rounds of CRS and HIPEC to treat peritoneal mesothelioma patients. This combination extended patient survival from 27.2 months to 80 months.
TTFields With Chemotherapy for Pleural Mesothelioma
TTFields recently became a treatment option for mesothelioma patients. By using low-intensity electrical currents, TTFields may slow or stop cancer growth. TTFields are administered with the Optune Lua™ device, formerly known as NovoTTF-100L™. This system was FDA-approved in combination with pemetrexed and platinum-based chemotherapy.
One study treated pleural mesothelioma patients with TTFields and chemotherapy. 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
Patients can prepare for chemotherapy in various ways. Each patient’s experience with mesothelioma chemotherapy may be slightly different. But individuals can keep in mind some general expectations for their preparation. For example, chemotherapy may lead to some common side effects. By knowing what to look for, patients can work with their doctor to help manage any that occur.
Patients can speak with their care team about the details of their specific plan. The care team can explain mesothelioma chemotherapy protocol, for either intracavitary 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 some patients, systemic chemotherapy may be part of their treatment plan. This means doctors will deliver it in the form of an injection, IV infusion or pill. Patients may experience a systemic chemotherapy process like the one below.
Example of a Chemotherapy Procedure: Alimta + Cisplatin
- For pleural mesothelioma, patients receive Alimta in 21-day cycles.
- During the week before treatment, patients take five daily doses of folic acid. They also receive one intramuscular injection of vitamin B12 during this time.
- Patients may receive a corticosteroid before, during and/or after Alimta treatment.
- On the first day of treatment, patients will receive Alimta. They receive cisplatin 30 minutes after an Alimta infusion. Their doctors will determine the appropriate dosage of each.
- Patients generally rest and recover for the rest of the 21-day cycle.
This Alimta and cisplatin procedure is one example of how chemotherapy may be administered. The process may differ based on a patient’s individual case and treatment plan. Side effects may also vary patient-by-patient. A patient’s care team can help them understand potential side effects and what to expect.
Some side effects, such as hair loss and nausea, may also 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 wellbeing, like support groups.
Patients can speak with their care team to understand what their experience may be like. This may help patients and their team better navigate the treatment.
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.
Each cycle commonly lasts for a few weeks but may be different for some patients. For example, the typical Alimta and cisplatin treatment has 21-day cycles.
The number of mesothelioma chemotherapy treatment cycles varies by patient. This depends on the patient’s case and other aspects 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.
06. Chemotherapy and Prognosis
Chemotherapy and Mesothelioma Survival
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
Patients should talk with their doctor to understand the expectations for their case.
Can Chemotherapy Cure Mesothelioma?
Although chemotherapy cannot cure malignant mesothelioma, it may offer other benefits. For some patients, chemotherapy may ease symptoms and improve their quality of life. It may also extend survival in some cases.
Doctors 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.
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 report various 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
- 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)
Patients should discuss any side effects with their doctors. 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 doctor will determine what other treatment options may work better.