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.

Doctor looking over mesothelioma tomography test results.

How Is Chemotherapy Used to Treat Mesothelioma?

This type of cancer treatment kills tumors and prevents 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, this form of treatment fights the tumors in two ways: either destroying individual cells or preventing their growth by disrupting cell division. The medication may be used alone but is often part of a multimodal treatment program, in which it is combined with radiation, surgery or immunotherapy.

With so many medications available, 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.

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Administering Chemotherapy for Mesothelioma

Patients can receive this form of treatment in two ways: systemically or intraoperatively.


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


This process takes place in the operating room after a surgeon has removed all visible mesothelioma tumors. Medication is applied directly to the affected area of the body, helping to kill any microscopic cancer 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,” the procedure delivers a dose of heated chemotherapy medication 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 to 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 (often meaning fewer side effects). Some patients may experience digestive issues for a few weeks after HIPEC.

Multimodal Treatment Plans

This form of treatment 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 administered to the patient’s body right after surgery to destroy any microscopic cancer cells not visible to the eye.

Chemotherapy Medications That Target Mesothelioma

The Food and Drug Administration (FDA) 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 varies depending on the individual patient.

Pemetrexed can also be combined with carboplatin, while cisplatin complements gemcitabine. An oncologist will determine which type of chemotherapy work best for you. Some variations of this medication the 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.

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How to Prepare

The type of medication and the duration of chemotherapy treatment is based on an individual’s diagnosis. Each 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 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 cancer treatment 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 Someone to Rely on

Side effects (including vomiting, nausea, or exhaustion) may lead to longer recovery times 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.

Common Side Effects

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

Common side effects include:

  • Nausea
  • Diarrhea
  • Vomiting
  • Body bruises
  • 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 complementary treatments to help relieve any symptoms you experience.