After a mesothelioma diagnosis, chemotherapy is part of the standard treatment plan for patients, also called ‘first-line therapy.’ Oncologists prescribe a combination — or cocktail — of drugs for each case. The goal: to find an effective dose that kills cancer cells and prevents new ones from developing, while balancing the potential side effects.
Chemotherapy Drugs That Target Mesothelioma
A combination of two drugs, Pemetrexed and cisplatin, has proven the most effective for the majority of mesothelioma patients. This treatment is administered intravenously, and the dose and number of treatments will vary, depending on the patient. Pemetrexed may also be combined with carboplatin, which has been shown to have less-severe side effects, while cisplatin complements gemcitabine.
Chemotherapy Drugs Used to Treat Mesothelioma
- Pemetrexed (ALIMTA®)
- Cisplatin (Platinol®)
- Vinorelbine (Navelbine®)
- Bevacizumab (Avastin®)
Oncologists may use combinations of these medications or administer single doses for patients who have trouble tolerating more than one drug.
Chemotherapy treatments can be administered systemically — throughout the entire body — or intraoperatively during surgery.
- Patients either receive chemotherapy intravenously or in pill form. This allows the drugs to enter the bloodstream and kill cancer cells throughout the body. Systemic treatments destroy both cancerous and healthy cells, and as a result tend to cause more side effects.
- After removing any visible tumors, a surgeon delivers chemotherapy drugs directly to the affected part of the body. In some cases, this method helps negate some of the side effect patients experience. Intrapleural chemotherapy and heated intraperitoneal chemotherapy — also called HIPEC — are the two most common examples of intraoperative chemotherapy.
Hyperthermic intraperitoneal chemotherapy is a targeted treatment for peritoneal mesothelioma. Patients receive a dose of heated chemotherapy drugs directly into the abdomen to destroy any microscopic cancer cells that may remain after surgery. This procedure, often called “hot chemotherapy,” is used after a surgeon has removed all visible lesions and tumors. The drugs, usually a combination of cisplatin and doxorubicin, are heated to 103 degrees Fahrenheit and pumped into the abdominal cavity. For two hours, a surgeon moves the patient back and forth on the operating table to ensure the drugs are distributed to all affected areas.
Compared to traditional chemotherapy, HIPEC has several benefits: it’s a single course of treatment as opposed to one that lasts for several weeks, it allows for a more concentrated dose of chemotherapy, and because the drugs remain within the abdominal walls, patients report fewer overall side effects. Digestive issues can develop and last for a few weeks after HIPEC. Patients should talk to an oncologist to find out more about this treatment option.
Chemotherapy drugs may be administered as a standalone treatment but are generally used as part of a multimodal treatment program, combined with radiation and, if necessary, surgery.
- Neoadjuvant Therapy:
- A course of chemotherapy to help shrink tumors before the patient undergoes surgery.
- Adjuvant Therapy:
- Treatment used after surgery to destroy any microscopic cancer cells that may be left behind.
Chemotherapy Treatments: How to Prepare
An oncologist will determine the length of treatment and type of chemotherapy drugs based on an individual’s diagnosis. When it comes to treating mesothelioma, each patient has a different path and faces different challenges, but preparing for treatment can reduce stress and help improve recovery time. Here are some general guidelines to ensure the body and mind are ready.
- Get tested: Doctors and oncologists will run a series of tests before treatment, assessing heart, lung, and kidney function to ensure the patient is healthy enough to begin chemotherapy. These screenings will also help determine the type and appropriate dosage of drugs to use.
- See the dentist: Healthy teeth and gums are essential for overall well-being, and even more so when undergoing chemotherapy. A dentist will look for — and treat — any signs of infection. Since certain drugs affect the immune system, it’s important to address any possible issues before starting chemotherapy.
- Rest and relax: Arrive at the doctor’s office as rested and relaxed as possible. While the idea of chemotherapy is stressful for many patients, consider it a positive part of the healing process.
- Ask for help: Certain side effects, like nausea and vomiting, may mean patients will have to stay close to home or in bed during recovery. It can be helpful to have a few family members or close friends around to run errands and assist with basic household chores.
Common Side Effects of Chemotherapy
While receiving chemotherapy treatments, most patients will experience some side effects. Different drugs and dosages can affect patient health in various ways. Common chemotherapy side effects include:
- Body bruises and mouth sores
- Diminished appetite
Late-stage side effects
Depending on the type of chemotherapy drugs, specific side effects may not appear for months or even years after treatment.
- Heart or lung damage
- Nerve problems
- Kidney disease
While these side effects are common during chemotherapy treatments, they don’t have to disrupt daily life completely. Talk to your doctor about medications and other therapies that can help alleviate symptoms.