How Is Chemotherapy Used to Treat Mesothelioma?

Systemic Chemotherapy for Mesothelioma

Patients either receive chemotherapy intravenously or in pill form. This allows the drugs to enter the bloodstream and kill cancer cells throughout the body. Unfortunately, systemic treatments destroy both cancerous and healthy cells and, as a result, tend to cause many side effects. Most side effects are due to targeting cells that divide quite rapidly and are usually found in the bone marrow, hair, and the gastrointestinal tract. This process causes the most common side effects, such as low bone marrow, hair loss, nausea, vomiting, and diarrhea.

Intraoperative Chemotherapy for Mesothelioma

After removing any visible tumors, a surgeon may deliver chemotherapy drugs directly to the affected cancer site of the body. In some cases, this method helps negate some of the side effects that patients experience. Intrapleural chemotherapy and heated intraperitoneal chemotherapy — also called HIPEC — are the two most common examples of intraoperative chemotherapy. Administration of local chemotherapy is thought to kill cancer cells directly, but it can also cause local inflammation in the pleural or peritoneal cavity.

Oncologists will prescribe a combination of drugs for each case. The goal here is to find an effective dose that kills cancer cell types and works to prevent new ones from developing while balancing the potentially serious side effects (i.e., nausea, bone marrow suppression, hair loss, etc.).

Multimodal Treatment for Mesothelioma

Patients may receive chemotherapy drugs as a standalone treatment or as part of a multimodal treatment program combined with radiation and, if necessary, surgery. Neoadjuvant Therapy is a course of chemotherapy used to help shrink tumors before the patient undergoes surgery, while Adjuvant Therapy treatment is used after surgery to destroy any microscopic cancer cells that may be left behind. This is more like sterilizing the body from any leftover cancer cells that couldn’t be seen and removed or have escaped from the surgical site and are hiding somewhere else in the body.

Chemo Drugs That Target Mesothelioma

In 2004, after reviewing the results of several studies, the Food and Drug Administration approved the combination of ALIMTA® (pemetrexed) and cisplatin for the treatment of mesothelioma. Patients who received this combination of drugs lived several months longer than those who received cisplatin alone. This treatment is administered intravenously, and the dose and number of mesothelioma treatments will vary depending on the patient’s needs. Pemetrexed may also be combined with carboplatin. You will work directly with your oncologist to determine the best types and duration of chemotherapy. regimen for your needs, including:

• Bevacizumab (Avastin®)
• Carboplatin
• Cisplatin (Platinol®)
• Doxorubicin
• Gemcitabine
• Methotrexate
• Mitomycin
• Pemetrexed (ALIMTA®)
• Vinorelbine (Navelbine®)

Oncologists may use combinations of these medications or administer single doses for patients who have trouble tolerating more than one drug. Your oncologist may also offer you an experimental treatment agent or a standard chemotherapy drug.

Chemotherapy Drugs Risk-Benefit Profile and Adverse Reactions

Understanding the risk-benefit profile and potential adverse reactions of chemotherapy drugs is important when planning your cancer treatment journey. It empowers patients and their healthcare providers to make informed decisions tailored to individual needs, ensuring that treatment advantages align with the patient’s personal goals. This knowledge not only helps manage expectations and reduce anxiety but also allows for better monitoring and intervention to mitigate side effects.

Additionally, it plays a role in promoting adherence to treatment plans, ultimately improving outcomes and enhancing the patient’s quality of life during chemotherapy. In this way, knowledge about chemotherapy’s risks and benefits, along with the proactive management of adverse reactions, is a vital component of comprehensive cancer care.

• Bevacizumab (Avastin®): Bevacizumab, an anti-angiogenic drug, has aided cancer treatment benefits but poses concerns about adverse events. It is effective in various cancers, but identifying responsive patient groups is crucial. A meta-analysis found a 2.9% incidence of fatal adverse events, primarily associated with taxane-based therapy, with hemorrhage and neutropenia being the main causes. Concerns about anticoagulation safety in bevacizumab-treated cancer patients have been raised due to an elevated risk of bleeding and venous thromboembolism.
• Gemcitabine: Gemcitabine (GCB), a widely used cancer drug, is generally well-tolerated but can cause severe acute toxicity, even fatalities, in some cases. Four such cases were reported following GCB treatment alone or with cisplatin. The rapid onset of these adverse events raised concerns about the GCB and cisplatin combination, leading occasionally to inducing oxidative stress and multi-organ failure. Some patients in the study had genetic variations in the cytidine deaminase (CDA) gene, a key enzyme in GCB metabolism, suggesting a genetic predisposition to GCB toxicity. While assessing CDA gene variations is relatively simple, it’s not a routine practice, but it could enhance the safety of GCB treatment, particularly in patients with factors that increase their risk of adverse effects.
• Methotrexate: Methotrexate, a well-established and highly effective systemic treatment, has well-documented long-term adverse effects, setting it apart from newer treatments. Common side effects include abnormal liver function tests, nausea, and gastric complaints, while myelosuppression and hepatotoxicity are of major hepatotoxicity are of major concern, linked to high cumulative doses which are linked to a high cumulative dosage of the agent.
• Mitomycin: Mitomycin is a chemotherapy drug used to treat various cancers, with common side effects including a risk of infection due to lowered white blood cell count, bleeding tendencies, anemia, nausea, skin and lung issues. Kidney problems are rare but monitored, and adequate fluid intake is crucial. Less common side effects involve sore mouth, diarrhea, appetite loss, and temporary hair thinning, which typically grows back after treatment. Always report side effects to your healthcare team.
• Pemetrexed: Pemetrexed injection is used in various cancer treatments, including metastatic, non-squamous non-small cell lung cancer (NSCLC), maintenance treatment of advanced NSCLC, and malignant pleural mesothelioma. Side effects may include allergic reactions, infection risk, anemia, and skin issues. It’s important to consult your doctor before taking other medications.

Hyperthermic Intraperitoneal Chemotherapy Option – (HIPEC Procedure)

Hyperthermic intraperitoneal chemotherapy is a targeted treatment for peritoneal mesothelioma. Patients receive a dose of heated chemotherapy drugs directly into the abdomen during or after surgery to destroy any microscopic cancer cells that may have remained after surgery. This procedure, often called “heated chemotherapy,” is used after a surgeon has removed all visible lesions and tumors. HIPEC is administered for approximately 30 minutes at a temperature of roughly 109 degrees Fahrenheit. The heat has been shown to increase the absorption of drugs by the tumor. A surgeon moves the patient back and forth on the operating table for two hours to distribute the drugs and reach all affected areas.

Compared to traditional chemotherapy, HIPEC has several benefits: It’s a single course of treatment instead of one that lasts several weeks; it allows for a more concentrated dose of chemo; and because the drugs remain within the abdominal walls, patients report fewer overall side effects. However, digestive issues can develop and last for a few weeks after HIPEC. Patients should talk to an oncologist at a proper cancer medical center to learn more about this treatment and whether it is an option. Some patients may not be eligible for this treatment due to advanced disease or specific type of mesothelioma.

An oncologist will determine the length of treatment and type of drugs based on an individual’s mesothelioma 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.

Before Starting Treatment

• Schedule Screenings: Oncologists will run a series of tests before treatment begins by assessing the heart, lungs, and kidneys function to ensure that the patient’s body is well enough to begin chemotherapy. These screenings will also help determine the appropriate drug type and dosage. Chemotherapy drug shortages are also sometimes reported, so calling ahead is always wise.
• Make Appointment to see the Dentist: A dental exam will ensure your teeth and gums are healthy and don’t have any signs of infection. Chemotherapy drugs are used to kill cancer cells, but they can also damage healthy cells in the mouth. Side effects include a swollen or blistered tongue, pain in the gums, and decreased saliva. These symptoms can worsen if there is a preexisting oral infection. A dentist will not only examine and clean your teeth but he or she can also provide tips or prescribe supplements to keep your mouth healthy during treatment.
• Get Enough Rest and Relax: Arrive at the doctor’s office as well-rested and relaxed as possible. While the idea of treatment is stressful for many patients, consider it a positive part of the healing process. Maintaining a positive outlook will help to improve mental health support and the process as a whole.
• Don’t be Afraid to 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. Having a few family members or close friends around can be helpful to run errands and assist with basic household chores. There are also useful companies that offer key services such as dog walking, grocery shopping and meal delivery for a fee.