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Mesothelioma Medications and Anti-cancer Drugs

Chemotherapy drugs are typically the most effective in treating mesothelioma, a cancer similar to lung cancer caused by exposure to asbestos. However, several additional anti-cancer drugs are often paired with treatment. Once an oncologist diagnoses a patient with asbestos-linked mesothelioma, he or she will develop a treatment plan. The program includes a combination of legal medical therapies, including chemotherapy, radiation, or emerging treatments for an optimal outcome. Typically, treatment begins with a focus on the source (i.e. the lining of the lung, abdomen, or heart). Generally, treatments used to treat mesothelioma include:

Deciding which treatment to use hinges on several factors: how far the disease has spread in the lung, chest, or heart membranes, the patient’s medical history, their personal history (including exposure to asbestos and other lung contaminants or cancer-causing carcinogens), and the patient’s current medical standing. Specialists perform specific tests to determine the majority of this information.

Tests may include:

  • CT scans of the lung, heart, and abdomen
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Molecular analysis of malignant mesothelioma

These tests enable your physician to determine the stage of cancer and develop an effective treatment plan. These tests aren’t always required. It depends on the patient and each situation.

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Chemotherapeutic Medications

Often, chemotherapy is paired with anti-cancer drugs for maximum effect. There are several different types of chemotherapy medications used to treat mesothelioma. Some of those include:

  • Pemetrexed (Alimta)
  • Cisplatin
  • Carboplatin
  • Gemcitabine (Gemzar)
  • Vinorelbine

Specialists administer chemotherapy to mesothelioma patients in multiple ways. Typically, administration depends on how far the cancer has spread, where it’s located, and other health factors. For instance, pleural mesothelioma of the lung may require a biopsy of the lung tissue as well as the nearby chest cavity. Extensive evaluations may be conducted to find the best combination of chemotherapeutic agents for maximum efficacy. Currently, the best results are combining chemotherapy treatment with surgery.

Chemotherapy can be administered in several forms:

Systemic Chemotherapy

Systemic chemotherapy refers to the administration of chemotherapeutic medication into the blood through a vein by a specialist. Typically, chemotherapy goes into the bloodstream and throughout the body to destroy cancer cells.


Intrapleural or Intraperitoneal Chemotherapy

Chemotherapy drugs can be administered directly into the pleura, or chest cavity, or into the peritoneum, the abdominal cavity. Doctors use a catheter for this treatment, placing it through a small incision located in the chest or abdominal wall.


How Chemotherapy Helps

Chemotherapy is often used in combination with other medications or treatments. If the tumors are small enough, chemotherapy works as a standalone treatment. Chemo can also be used after radiation and surgery to attack the microscopic cancer cells not visible to the naked eye. Additionally, chemotherapy helps prepare patients for different treatment methods, such as shrinking a tumor before surgery, known as neoadjuvant therapy. Finally, in cases where the tumor is unresectable, chemo helps relieves cancer symptoms or extend survival, also known as palliative chemotherapy.


Side-Effects of Chemotherapy

Chemo medications are designed to attack and kill rapidly dividing cells. Unfortunately, cancer cells aren’t the only cells in the body that divide quickly. Bone marrow, the lining of the mouth and intestines, and hair follicles all contain cells that divide at a rapid pace. This can lead to several potential side effects:

  • Diarrhea
  • Loss of Hair
  • Loss of appetite
  • Vomiting and Nausea
  • Fatigue
  • Increased chance of infections, bruising or bleeding
  • Sores in the mouth

There are multiple ways and medications that doctors use to mitigate complications and relive the side-effects of chemotherapy. Talk to your physician to learn about different options based on your specific case. However, the side-effects usually wear off once the treatment cycle is complete.

Targeted Treatment

Unlike chemotherapy, which uses medications to treat cancer by attacking all cells; targeted therapy attacks cancer-specific genes, proteins, or the tissue environment that aids in cancer growth and survival. Currently, there are multiple targets that scientists and physicians continue to explore in treating mesothelioma of the lung, heart, and abdominal cavities.

Examples of types of targeted therapy include:

Anti-Angiogenesis Therapy

Angiogenesis is the creation of new blood vessels and is a normal function of healing and growth in the body. Unfortunately, if a person has cancer, angiogenesis also helps cancer cells multiply and spread. When new blood vessels form, they carry blood containing nutrients and oxygen to the tumors, enabling them to grow.

Anti-angiogenesis drugs stop the growth of new blood vessels, blocking angiogenesis, consequently “starving” the tumors and stunting their ability to grow and spread to other parts of the body. Angiogenesis inhibitors, also known as small-molecule drugs, include:

  • Bevacizumab (Avastin)
  • Ramucirumab (Cyramza)
  • Cediranib


Monoclonal Antibodies

Monoclonal antibodies are made to block a specific target on the outside of cancer cells or to send toxic substances directly to the harmful cells. They’re also a form of immunotherapy and are used as a substitute for immune system proteins to destroy cancer cells. These antibodies are designed to attack specific areas on diseased cells. Monoclonal antibodies are also used in combination with chemo and radiation therapies.


Epidermal Growth Factor Receptor Inhibitors (EGFR)

Medications that have been used in clinical trials to inhibit the Epidermal Growth Factor Receptor Inhibitor in mesothelioma patients include:

  • Afatinib (Gilotrif)
  • Gefitinib (Iressa)


How Targeted Therapy Helps

Since targeted therapies mainly attack specific genes, proteins, or tissues that help cancer grow and spread, side-effects are typically less severe, and not as damaging to healthy cells.


Side-Effects of Targeted Therapy

Targeted therapy inhibits normal cell functions to attack cancer. Side-effects can include:

  • High blood pressure
  • Fatigue
  • Nausea or Diarrhea
  • Bleeding
  • Low white blood cell counts and an increased risk of infections
  • Headaches and pains
  • Sores of the mouth
  • Lost appetite

Photodynamic Treatment

Photodynamic therapy (PDT) is also a type of targeted treatment that combines a photosensitizer or photosensitizing agent, and light to target and destroy specific abnormal cells. PDT works when the photosensitizers are exposed to particular wavelengths of light that cause the formation of oxygen, consequently killing cancer cells.

How Photodynamic Treatment Helps

Historically, photodynamic therapy medications have improved an asbestos-caused mesothelioma prognosis. Since the wavelength determines how far the light travels into the body, doctors use wavelengths and photosensitizers to project the light into different areas of the body. A medication used explicitly in treating mesothelioma is called porfimer sodium (Photofrin).

Side-Effects of Photodynamic Treatment

Porfimer sodium makes the eyes and skin hypersensitive to light for about six weeks once treatment has stopped. Patients who have undergone photodynamic therapy are advised to stay away from direct sunlight and bright indoor lights for this time.

Immunotherapy

Immunotherapy is another type of targeted therapy that has grown quite popular because of its success. The treatment medications target the patient’s immune system to fight cancer. This treatment stimulates the immune system to work more efficiently, attacking cancerous cells and boosting the immune system with useful additives, including human-engineered immune system proteins. Some of the currently used immunotherapy drugs include Pembrolizumab (Keytruda), Nivolumab (Opdivo) and Ipilimumab (Yervoy).

Researchers are still testing multiple, different immunotherapy treatments in clinical trials:

  • Atezolizumab (Tecentriq)
  • CRS-207
  • Durvalumab
  • Nivolumab (Opdivo)
  • Pembrolizumab (Keytruda)
  • Tremelimumab
  • Ipilimumab (Yervoy)

Doctors and researchers target the immune system using several different methods. These include immune checkpoint inhibition, cancer vaccines, and other forms of immunotherapies.

  • Immune Checkpoint Inhibitors – Medications that allow the immune system to locate and destroy cancer cells.
  • Cancer Vaccines – Vaccines trigger an immune response against certain diseases and are often used in cancer treatment and prevention.
  • Other Immunotherapies – These therapies bolster the immune system and encourage it to attack cancer cells.

How Immunotherapy Helps

Unlike chemotherapy, which attacks both healthy and cancerous cells, immunotherapy offers a more targeted approach, with fewer side-effects. When doctors administer immunotherapies, they strengthen the body’s defenses and enable white blood cells to locate and kill cancer cells.

Side-Effects of Immunotherapy

The side-effects for immunotherapy include:

  • Fatigue
  • Fever
  • Shortness of breath
  • Nausea or vomiting
  • Weight loss
  • Skin rash or blisters
  • Insomnia
  • Diarrhea

Most of these side effects are mild but serious and life-threatening complications can happen. If you ever visit the emergency department or meet a new doctor while you are on immunotherapy, it is important to let the doctors know you are taking immunotherapy. Some institutions provide patients with legal medical cards to carry on them with the name of the medications in case they need to visit the Emergency Department with new, unusual or severe symptoms.

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Clinical Trials

Clinical trials are a critical pillar of mesothelioma research. These studies allow doctors to discover innovative ways to improve patients’ quality of life in a safe and legal environment. Too, clinical trials are available for patients at every stage (not simply advanced stages), as well as those with recent asbestos exposure.

Some mesothelioma medications being tested in clinical trials are:

  • PARP inhibitors (Olaparib and Rucaparib)
  • LMB-100
  • Pevonedistat
  • Defactinib
  • Ramucirumab
  • Anetumab Ravtansin

How Clinical Trials Help

Clinical trials help researchers experiment by legal means with new ways to prevent exposure, diagnose cancer, treat and manage symptoms and side-effects of cancer, and develop better treatment. Presently, researchers are working on ways to detect damage done by asbestos exposure sooner as well as giving more quality years to patients in late stages of mesothelioma and lung cancer. There are many clinical trials available for mesothelioma patients. Visit ClinicalTrials.gov for a complete list of legal ongoing and completed trials and their locations.

Side-Effects of Clinical Trials

Side-effects of clinical trials vary, based on the type and combination of medications and therapies.

Radiation Treatment

While there are no radiation-specific medications, except for medications administered to relieve radiation side-effects, anti-cancer drugs are paired with radiation treatment as a form of neoadjuvant therapy. For example, oncologists will administer chemotherapeutic medications to shrink tumors before radiation treatment.

Radiation treatment is also used after surgery to kill remaining cancer cells. This form of therapy utilizes high-energy beams from X-rays and protons to target specific areas of the body. In advanced stages of cancer, radiation may be used to minimize signs and symptoms.

Mesothelioma Medications at a Glance

Medications used to treat cancer and mesothelioma caused by asbestos exposure vary and are continually being researched and tested. Researchers are regularly making discoveries that have the potential to change and improve legal anti-cancer drugs, including mesothelioma medications and therapies.

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