What Is Chemotherapy?

The human body is made up of billions of cells. Cancer cells divide and replicate much faster than normal cells, creating growths or tumors. Chemotherapy drugs are used to treat cancer by dramatically slowing or stopping cancer cells from dividing. Some types of chemotherapy destroy individual cells, while others disrupt the cell-dividing process. Chemotherapy drugs may be administered as a standalone treatment but are generally used as part of a multimodal treatment program, combined with other mesothelioma medications, radiation and, if necessary, surgery.

Chemotherapy treatments can be administered in two ways: systemically (throughout the entire body) or intraoperatively (during surgery).

This is an icon representing systemic chemotherapy.

Systemic Chemotherapy

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. Most chemotherapy side effects are due to it targeting cells that divide rapidly like bone marrow, hair, and the gastrointestinal tract. This causes common side effects like low bone marrow, hair loss, nausea, vomiting, and diarrhea.

This is an image representing intraoperative chemotherapy.

Intraoperative Chemotherapy

After removing any visible tumors, a surgeon may deliver chemotherapy drugs directly to the affected part 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 prescribe a combination of drugs for each case. The goal: to find an effective dose that kills cancer cells and works to prevent new ones from developing while balancing the potentially serious side effects, such as nausea, bone marrow suppression, hair loss, etc.

Multimodal Treatment

Patients may receive chemotherapy drugs as a standalone treatment, or as part of a multimodal treatment program, combined with radiation and, if necessary, surgery.

This is an icon displaying a therapy taken after the neoadjuvant mesothelioma treatment.

Neoadjuvant Therapy

A course of chemotherapy to help shrink tumors before the patient undergoes surgery.

This is an icon displaying a therapy taken after the adjuvant mesothelioma treatment.

Adjuvant Therapy

Treatment used after surgery to destroy any microscopic cancer cells that may be left behind. This is more like sterilizing the body from any leftover cells that couldn’t be seen and removed or escaped the surgical site and hiding somewhere else in the body.

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Chemotherapy 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 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 types and duration of chemotherapy.

Chemotherapy Drugs Used to Treat Mesothelioma

  • 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 or chemotherapy.

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 the drugs by the tumor. For two hours, a surgeon moves the patient back and forth on the operating table 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 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 and if it is an option. Some patients may not be eligible for this treatment due to advanced disease or specific type of mesothelioma.


Video Transcript

“I am doing chemo. I have chemo every three weeks. I take the treatment and then I’m down for about a week, and then I have two weeks to recoup. I still have nausea. I am extremely tired and I don’t have any energy, and I cannot eat. And the smells? Everything’s totally different.” Inez St. John, Patient

An oncologist will determine the length of treatment and type of chemotherapy 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 Treatment

  • Schedule Screenings: Doctors and oncologists will run a series of tests before treatment, assessing the heart, lungs, and kidneys function to ensure the patient is healthy enough to begin chemotherapy. These screenings will also help determine the appropriate drug type and dosage.
  • 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.
  • 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. There are also companies that offer services such as dog walking and grocery and meal delivery for a fee.

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 side effects include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Body bruises and mouth sores
  • Fever
  • Fatigue
  • Diminished appetite
  • Changes in taste
  • Numbness or tingling in hands or feet

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
  • Infertility
  • 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 emerging treatments that can help alleviate symptoms.

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