Mesothelioma Drugs and Medications

Types of Mesothelioma Drug Treatment

A mesothelioma drug is any non-food substance used to treat or relieve symptoms of mesothelioma cancer. Doctors commonly use drugs to improve prognosis and quality of life for mesothelioma patients. Some drugs may also help relieve symptoms.

Mesothelioma drugs fall into three general categories:

• Chemotherapy drugs: This type of drug generally kills fast-growing cells. Chemotherapy is a standard treatment for several forms of mesothelioma. It has improved life expectancy for many patients.
• Immunotherapy drugs: This type of drug recruits the immune system to fight cancer. Immune checkpoint inhibitors (ICIs) are the most common form of immunotherapy for mesothelioma. The ICI combo of Opdivo® + Yervoy® is a standard treatment for inoperable pleural mesothelioma. Opdivo + Yervoy has boosted survival and quality of life for many patients.
• Other drugs: Other drugs sometimes used for mesothelioma include targeted therapies and photosensitizers. Targeted therapies like Avastin® (bevacizumab) interfere with cancer cells’ ability to grow and divide. Photosensitizer drugs work together with specific types of light to kill cancer cells. This approach is called photodynamic therapy.

Mesothelioma is a rare cancer caused by asbestos exposure. This rarity can make the development of mesothelioma drugs challenging. Researchers often study new drugs in pleural mesothelioma, the most common of mesothelioma types.

As such, mesothelioma drugs generally earn approval for treating pleural mesothelioma. But doctors still use them for peritoneal mesothelioma and other rare cell types. When it seems advantageous, doctors may also use drugs approved for cancers other than mesothelioma.

Some mesothelioma patients undergo treatment with a single drug regimen. Others may take mesothelioma drugs alongside other therapies. Combination treatments (multimodal therapies) may extend survival better than a single therapy.

Multimodal treatments often combine chemotherapy and surgery. Some approaches also include radiation. Researchers are currently investigating the combination of chemotherapy and immunotherapy. This research may expand mesothelioma treatment options in the future.

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Chemotherapy Drugs Used to Treat Mesothelioma

Chemotherapy drugs treat cancer using substances that damage fast-growing cells. Cancer cells grow faster than healthy cells. So chemo kills mesothelioma cells, but its toxicity can cause side effects.

Patients can receive either systemic or local chemotherapy for mesothelioma.

• Systemic chemotherapy travels through the bloodstream. Patients may receive it intravenously (through an IV), as an injection or as a pill. Systemic chemo may cause more side effects than local. This type of chemo may also be called traditional chemotherapy.
• Local chemotherapy targets a specific area or body compartment. For mesothelioma, local chemo may go in the chest or abdominal cavities as a wash. Local chemotherapy may cause fewer side effects than systemic. This type of chemo may also be called targeted chemo, heated intraperitoneal chemotherapy (HIPEC) or hyperthermic intrathoracic chemotherapy (HITHOC).

The most common chemo drugs for all types of mesothelioma are Alimta and cisplatin. But doctors may prescribe other drugs to account for individual patient factors.

Alimta and Cisplatin for Mesothelioma

Alimta and cisplatin form the standard chemotherapy regimen for mesothelioma. This combination is the only FDA-approved chemotherapy for mesothelioma. Together, Alimta and cisplatin are approved for the treatment of inoperable pleural mesothelioma.

Alimta and cisplatin have been a standard mesothelioma treatment for nearly 20 years. But researchers are still looking for new, more effective ways to use them. Alimta and cisplatin will play a key role in several upcoming clinical trials.

One trial aims to find out if immunotherapy can further extend survival when given alongside Alimta and cisplatin. Another will investigate using Opdivo (checkpoint inhibitor), Alimta and cisplatin after surgery for pleural mesothelioma.

These and other research efforts may find more ways to improve survival and quality of life for mesothelioma patients.

There are also other mesothelioma chemotherapy drugs:

• Carboplatin is a platinum-based chemo drug, like cisplatin. But carboplatin tends to be a gentler option. This property may lead doctors to choose carboplatin for elderly patients or those in poor health. It is a standard option for qualified patients with pleural or peritoneal mesothelioma.
• Doxorubicin is a chemo drug that interferes with important cellular processes, causing cancer cells to die. It may be used alongside cisplatin to treat peritoneal mesothelioma. This combo is a standard option for local chemotherapy known as HIPEC.
• Gemcitabine is a chemo drug that interferes with important cellular processes and harms cancer cells. It may be used for some mesothelioma patients but is not the most common option.
• Navelbine is a chemo drug that binds to important proteins, causing cancer cells to die. It may be used for some mesothelioma patients but is not the most common option.

Common Side Effects of Chemotherapy Drugs

Chemotherapy drugs can kill cancer cells, but they also harm healthy cells. This means patients may have side effects. Common side effects of mesothelioma chemotherapy drugs include:

• Breathlessness (difficulty breathing)
• Fatigue
• Low blood cell counts
• Nausea
• Vomiting

Hair loss is a common side effect of many chemotherapy drugs. But the Alimta and cisplatin combo is less prone to causing hair loss than other drugs. Patients should report any side effects to their treatment teams. Healthcare providers can help manage side effects.

What to Expect From Chemotherapy Drug Treatment

A patient’s chemotherapy experience depends on individual factors and overall treatment approach. Systemic chemo generally requires an infusion appointment once every few weeks or so.

For instance, systemic Alimta with cisplatin treatment includes receiving vitamin injections and key supplements the week before infusion. This preparation helps reduce side effects.

Local chemo commonly takes place during or after mesothelioma surgery. Once tumors have been physically removed, doctors wash the affected body compartment with chemo drugs. The procedural details vary between individual patients and types of local chemo.

Patients can prepare for chemotherapy by following healthcare providers’ instructions. Patients and their caregivers can also discuss any treatment concerns with the care team. These discussions may cover aftercare guidelines and potential prescription interactions.

Immunotherapy Drugs Used to Treat Mesothelioma

Immunotherapy drugs turn the immune system against cancer cells. This can allow immune cells to target and kill mesothelioma tumors. Immunotherapy comes in many different forms. Of those, checkpoint inhibitors and CAR T cells have done the most for mesothelioma patients.

• Immune checkpoint inhibitors (ICIs) block checkpoints in the immune system. This allows immune cells to recognize and attack cancer. The ICI combo of Opdivo + Yervoy is the only immunotherapy with FDA approval for treating mesothelioma.
• CAR T cells are immune cells modified to recognize and attack cancer cells. Doctors collect regular immune cells from a patient, reprogram them, then give them back. CAR T cells do not yet have FDA approval for treating mesothelioma.

Opdivo and Yervoy for Mesothelioma

The combo of Opdivo + Yervoy has FDA approval for treating inoperable pleural mesothelioma. It is a standard treatment option. In a clinical trial, patients treated with Opdivo + Yervoy had a median survival of about 18 months. They also experienced improved quality of life compared to patients treated with chemo.

Several clinical trials are investigating new ways to use Opdivo, Yervoy and other ICIs. This research may lead to even more immunotherapy treatment options for mesothelioma.

Researchers are also studying other mesothelioma checkpoint inhibitor drugs:

• Imfinzi® (durvalumab) is an ICI that blocks the PD-1/PD-L1 checkpoint. It is not yet approved for mesothelioma but gave promising study results.
• Imjudo® (tremelimumab) is an ICI that blocks the CTLA-4 checkpoint. It is not yet approved for mesothelioma but gave promising study results.
• Keytruda® (pembrolizumab) is an ICI that blocks the PD-1/PD-L1 checkpoint. It is approved for treating tumors with many mutations, like some mesothelioma tumors.
• Tecentriq® (atezolizumab) is an ICI that blocks the PD-1/PD-L1 checkpoint. It is approved for some forms of lung cancer but not yet mesothelioma.

Common Side Effects of Immunotherapy Drugs

Immunotherapy side effects vary between patients and specific drugs and combos. For mesothelioma ICIs, common side effects include:

• Diarrhea
• Fatigue
• Pain (muscle or body aches)
• Rash

Some immunotherapy side effects happen because the drugs hamper immune cells’ ability to aim attacks. This means immune cells can strike more broadly and — at times — may target healthy cells and tissues. This type of side effect is called an immune-related adverse event (irAE). Some irAEs can become serious, but doctors have methods of handling them.

For Opdivo + Yervoy, experts say most side effects are manageable and resolve with standard treatment. Still, patients should promptly report all side effects to their oncologists or care teams. This can help secure timely and effective management.

Other Drugs Used to Treat Mesothelioma

Some mesothelioma medications fall outside the categories of chemotherapy and immunotherapy. These drugs use different approaches to kill cancer cells, like targeting important proteins.

Targeted Therapy Drugs

Targeted therapies interfere with proteins that allow cancer cells to grow, divide and spread. This interference can damage or kill tumor cells. No targeted therapies have FDA approval for treating mesothelioma. But some have done well in early studies.

Photodynamic Therapy Drugs

Photodynamic therapy (PDT) takes a creative approach to shrinking tumors. It uses a photosensitizer drug and light to kill cancer cells. Patients receive the photosensitizer ahead of time, allowing it to collect in tumor cells. Then a doctor shines a specific form of light on the tumor. This light reacts with the photosensitizer, setting off a chain reaction that kills the illuminated cells.

Several PDT drugs have FDA approval for treating certain cancers and other conditions. Researchers have investigated at least one of these drugs in mesothelioma.

In a small study, doctors treated pleural mesothelioma with surgery. Then patients received PDT with the photosensitizer Photofrin® (porfimer sodium). Some patients also had systemic chemotherapy. Median survival was more than 2.5 years.

The Future of Mesothelioma Drug Research

Mesothelioma patients currently have more treatment options than ever. These drugs and other therapies are a direct result of mesothelioma research, which is ongoing. Clinical studies are investigating experimental treatments and new combinations of existing therapies.

In general, mesothelioma drugs result from research into experimental treatments. This type of investigation helps doctors understand how best to help mesothelioma patients. For example, study data for a drug called NGR-hTNF showed it made no difference in survival.

The Opdivo + Yervoy clinical trial turned out very differently. It showed the drug combo boosted survival and quality of life for pleural mesothelioma patients.

However, patients may have different experiences depending on their own unique factors. A mesothelioma specialist can explain the benefits and risks of different drugs. This discussion can help patients understand the optimal choices for their individual situations.