Chemotherapy for Mesothelioma

Chemotherapy is one of the most common courses of treatment for malignant mesothelioma. It is used to slow or stop the spread of asbestos cancer and is often utilized in combination with surgery, radiation, and other treatments.

Mesothelioma Vets - Radiation

How Is Chemotherapy Used to Treat Mesothelioma?

Chemotherapy drugs kill cancer cells and prevent them from spreading throughout the body. Doctors usually prescribe a combination of chemotherapy medications for mesothelioma patients. This treatment is utilized at all stages of the disease and may be administered before, after, or even during other procedures.

Our bodies consist of billions of cells. Cancer cells spread much more quickly than healthy cells, creating abnormal growths or tumors. Chemotherapy drugs can slow or stop those diseased cells from dividing and further invading healthy organs and tissue. When used to treat mesothelioma, chemotherapy fights the tumors in two ways: either destroying individual cells or preventing their growth by disrupting cell division. Chemotherapy drugs may be used alone but are often part of a multimodal treatment program, in which they are combined with radiation and surgery.

With all chemotherapy treatments, oncologists must strike a delicate balance: to find an effective dose that destroys existing cancer cells and slows tumor growth while at the same time preventing potentially serious side effects in patients.

Administering Chemotherapy for Mesothelioma

Patients can receive chemotherapy in two ways: systemically or intraoperatively.

Systemic Chemotherapy

A combination of drugs is administered intravenously or in pill form. Systemic treatments allow the drugs to enter the bloodstream, targeting both diseased and healthy cells. For this reason, systemic chemotherapy treatments often have stronger side effects.

Intraoperative Chemotherapy

This process takes place in the operating room after a surgeon has removed all visible mesothelioma tumors. Chemotherapy drugs are then applied directly to that area of the body, helping to kill any microscopic cells left behind. Compared to systemic delivery, patients report fewer side effects. Intrapleural chemotherapy and heated intraperitoneal chemotherapy, known as HIPEC, are two common examples of intraoperative chemotherapy.

HIPEC Procedure

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a targeted intraoperative treatment for peritoneal mesothelioma. Sometimes referred to as “hot chemotherapy,” it involves delivering a dose of heated chemotherapy drugs directly into the abdomen. HIPEC takes place after surgery and is designed to destroy any microscopic cancer cells that may be left behind.

Once a surgeon has removed all visible tumors in the peritoneal cavity, the patient receives a mixture of chemotherapy drugs, heated to roughly 109 degrees. For the next two hours, the surgeon moves the patient back and forth on the operating table to ensure the drugs are distributed evenly and reach all affected areas.

HIPEC has several benefits when compared to other forms of chemotherapy: it only involves one course of treatment, it delivers a concentrated dose of heated medication directly to any remaining cancer cells, and the drugs remain within the abdominal cavity, which often means fewer side effects. Some patients may experience digestive issues for a few weeks after HIPEC. An oncologist can explain more about this particular treatment option.

Chemotherapy as Part of a Multimodal Treatment Plan

Chemotherapy drugs can be used alone or as part of a multimodal treatment program that also includes radiation, surgery, or other therapies.

Neoadjuvant Therapy
This course of treatment takes place before surgery. Doctors administer chemotherapy drugs to help shrink mesothelioma tumors, making the procedure less invasive.
Adjuvant Therapy
Chemotherapy drugs are delivered to the patient’s body right after surgery to destroy any microscopic cancer cells not visible to the eye.

Chemotherapy Drugs That Target Mesothelioma

The FDA (Food and Drug Administration) approved the use of ALIMTA® (pemetrexed) and cisplatin in 2004 after several studies showed mesothelioma patients who received a combination of these drugs lived several months longer than those who received a single course of cisplatin. This treatment is administered intravenously. Each dose and number of medications will vary depending on the individual patient.

Pemetrexed can also be combined with carboplatin, while cisplatin complements gemcitabine. An oncologist will determine which chemotherapy drugs work best for you. Some of the chemotherapy drugs doctors use to treat mesothelioma include:

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

Some patients may be more sensitive to combinations of chemotherapy drugs than others. In those cases, an oncologist may suggest a treatment plan that uses only one drug at a time.

How to Prepare for Chemotherapy

The type of chemotherapy drugs and the duration of chemotherapy treatment are based on an individual’s diagnosis. Each mesothelioma patient faces different challenges, but preparing for therapy can alleviate stress and even improve recovery time. Here are some general guidelines to consider.

Schedule screenings: Patients will undergo a series of tests before treatment to assess their lung, heart, and kidney function. These screenings also help doctors determine the most effective drug combinations and dosage.

Visit the dentist: Patients should schedule a dental exam before starting treatment to ensure their teeth and gums are healthy and don’t show any signs of infection. Chemotherapy drugs kill cancer cells, but they can damage healthy cells as well, including those in the mouth. Side effects of the treatment include gum pain or bleeding, dry mouth, and a swollen or blistered tongue. A preexisting infection can make these symptoms worse.

Get plenty of rest: The thought of receiving chemotherapy may cause some patients to feel anxious or overwhelmed, so it’s important to arrive for the treatment as relaxed and rested as possible. Consider this treatment a part of the healing process.

Find a helpful friend or family member: Side effects, including vomiting, nausea, or exhaustion, may lead to longer recovery time for some patients. In those situations, it’s helpful to have a family member or close friend who can assist with household chores or run errands if necessary.

Chemotherapy: Common Side Effects

Most patients will experience a few side effects as a result of receiving chemotherapy treatments. Different medications, dosages, and treatment courses will affect patients in various ways.

Common chemotherapy side effects include:

  • Nausea
  • Diarrhea
  • Vomiting
  • Body bruises and mouth sores
  • Fever
  • Fatigue
  • Diminished appetite
  • Late-stage side effects

Certain drugs may also cause side effects that do not appear for months or years after treatment. These can include:

  • Heart or lung damage
  • Infertility
  • Nerve problems
  • Kidney disease

Each course of chemotherapy has the potential to lead to different side effects. However, they don’t always have to affect your daily life. Ask your doctor to recommend medications and other therapies to help relieve any symptoms you experience.

Author: Elizabeth Schubert – Last Edited: October 30, 2019