Chemotherapy is an effective treatment for patients with malignant mesothelioma. It’s often used to complement other treatment options like surgery or radiation therapy.

Treating Mesothelioma With Chemotherapy

Chemotherapy is a treatment option widely used among all cancer patients to improve life expectancy. Like all other non-surgical options, chemotherapy is not a curative treatment and is best used in conjunction with other treatments (surgery and radiation).

Benefits of Chemotherapy

  • Improve Survival

    Combined with surgical procedures such as the extrapleural pneumonectomy or cytoreduction, chemotherapy can significantly aid in recovery and survival rates.

  • Patient Specialization

    There are a variety of different medications and methods. This allows specialists the ability to manage each patient’s tolerance and comfort uniquely.

Chemotherapy Basics

After being diagnosed with mesothelioma, patients meet with a medical oncologist who specializes in the nonsurgical treatment of the disease. Patients then undergo various testing procedures to help determine the best route of treatment.

The standard of treatment for most cases of mesothelioma is chemotherapy. Generally speaking, chemotherapy is designed to accomplish several goals, including:

  • Killing mesothelioma cells
  • Preventing cancerous cells from spreading
  • Shrinking tumors
  • Making other treatments, such as surgery, more effective
  • Relieving symptoms, mainly pain, caused by tumors

However, every patient is different and oncologists have to tailor chemotherapy on a patient by patient basis. This includes how long the chemotherapy is administered and how often it is given.

As treatment begins, doctors may try different drugs to determine which are most effective for their patient. Chemotherapy drug prescriptions may be altered if the patient experiences any adverse side effects.

Every patient responds to chemotherapy differently. A certain chemotherapy drug may add years to the life expectancy of one patient, while the same drug has little to no effect in another. The goal is to do the most damage to the cancer cells while protecting the patient’s health.

Chemotherapy is administered in rounds based on how well the patient is handling the treatment. Side effects such as fatigue are normal, but chemotherapy rounds are stopped if serious side effects emerge. Most patients have 3 to 4 rounds of standard chemotherapy.

Patients receive treatment in the hospital, at cancer treatment centers, at outpatient facilities or at home. Doctors and nurses ensure the patient isn’t in any discomfort while receiving their chemotherapy and monitor patients for unusual side effects or complications.

Types and Methods

There are chemotherapy types and methods that can be used in all stages of treatment for patients with mesothelioma. It is used for pain relief in patients with advanced mesothelioma and to prevent metastasis in early stage patients.

Treatment Types

Chemotherapy is commonly used on its own, but it also used in conjunction with radiation and surgery to produce the results for the patient. There are different stages during a patient’s treatment when chemotherapy can be utilized in a multimodal approach.

  • Neoadjuvant Chemotherapy – Administered prior to surgery to reduce size of tumors. This can make surgery easier and more successful.
  • Intraoperative Chemotherapy – Administered during surgery. Doctors are able to apply higher dosages of chemotherapy directly to tumors with less side effects.
  • Adjuvant Chemotherapy – Administered after surgery to kill remaining cancer cells. Microscopic mesothelioma cells cannot be removed with surgery, so adjuvant therapy could kill these cells.

Delivery Methods

Patients who receive chemotherapy may be given the drug in a variety of ways. The method in which they receive the chemotherapy is based on the type of mesothelioma they have, the location of the cancer, and their overall health.

  • Intravenous Delivery – The most common delivery method. Delivery can be a simple injection or an IV drip. Delivery can take anywhere from minutes to hours.
  • Chemotherapy Port – Patients whose treatment is extended may be fitted with a port to make delivery more convenient. Chemotherapy is delivered quickly and easily through a port.
  • Oral Delivery – Oral medications for mesothelioma are only available in clinical trials. This is the most convenient method, usually taken daily but in small doses.

Medications and Combinations

There are few chemotherapy drugs for treating mesothelioma that have been approved by the Food and Drug Administration. However, there are also drugs being used that have shown success at treating mesothelioma that have not yet been approved. These drugs have also shown far better success when they are combined and delivered.

There are a variety of mesothelioma medications available for patients, and the most common medications are Alimta and cisplatin. This is the most common combination of chemotherapy drugs.

The outlook for future chemotherapy patients is steadily improving with the development of new trials conducted by mesothelioma specialists.

Jill Litton

Jill

Jill Litton was diagnosed with peritoneal mesothelioma at the age of 52 and prescribed multimodal treatment, including surgery and chemotherapy. During her surgery, she was treated with heated chemotherapy (HIPEC). HIPEC has become commonplace in the treatment of peritoneal mesothelioma.

Following her surgery, she underwent 2 cycles of traditional chemotherapy (Alimta and cisplatin). After experiencing uncomfortable side effects, her doctors later revised her prescription to replace cisplatin with carboplatin, which was successful.

She’s thankful for her medical team and their attention. Jill is living proof of the value of chemotherapy treatments and mesothelioma specialist care. She spends her time with her husband and family in West Virginia.

“I’ve been blessed with such wonderful medical professionals.”

Multimodal Chemotherapy

Chemotherapy is most successful when used in combination with other treatment tactics, such as was Jill Litton’s case. Surgery and chemotherapy, whether adujvant or intraoperative, is the most common combination. Renowned pleural mesothelioma specialist, Dr. Raja Flores, recently conducted a study on intraoperative chemotherapy to evaluate the benefits of multimodal therapy.

The study shows that intraoperative chemotherapy after an extrapleural pneumonectomy can increase the average life span from 17 months to over 33 months.

Dr. Flores, based out of New York City’s Mount Sinai Hospital, is considered highly experienced with administering intraoperative chemotherapy. He is also one of the best surgeons in the field and performs both the extrapleural pneumonectomy and the pleurectomy with decortication. Get connected to specialists like him using our free Doctor Match program.

Process

  • 1

    Initial Consultation

    If chemotherapy is part of a patient’s treatment plan, patients first consult with their oncologist. Oncologists specialize in using chemotherapy to treat a variety of cancers and treat each diagnosis uniquely. Patients have the opportunity to discuss their upcoming treatments and receive questions to any of their questions.

    During the visit, patients are examined fully and the oncologist may consult with a multimodal team (such as surgeons or radiation oncologists) to offer opinions. It’s advised that patient’s bring their entire medical file (X-rays, lab tests, pathology and more) to be reviewed by their oncologist. Initial consultations give the patient a solid understanding of their treatment plan.

  • 2

    Informed Consent

    Patients have the right to know every aspect of their treatment plan when they are preparing to undergo chemotherapy. Oncologists lay out the entire treatment schedule, which includes the frequency of visits and the length of time to complete treatment.

    They’ll also share information about the medications they’ll be using and any expected side effects. Patients then sign an informed consent form, indicating that they understand their treatment and give approval to move forward. Patients may withdraw their consent at any time for any reason.

  • 3

    Treatment Planning

    If a patient is receiving intravenous chemotherapy, they may need to have a device inserted before the chemotherapy can begin. This device may be a catheter, port, or pump. Chemotherapy drugs are delivered via this device. Patients should also plan ahead.

    They should expect to feel slightly sick, especially after their first dose of chemotherapy. Patients should have a friend or family member drive them to and from their first appointment. Some side effects may affect the way patients drive. They should also be prepared to take a few days to take it easy.

    Chemotherapy affects people in different ways and until patients are aware of how the drugs work with them, they should take caution.

  • 4

    Receiving Treatment

    Most chemotherapy treatments are given in a comfortable setting and supervised by a chemotherapy nurse. When patients require more attention or medical care, they may receive their treatment in a hospital. In some cases, patients receive their chemotherapy at home.

    Treatment time varies by case, and is on average 1-3 times per week during a multi-week cycle. During treatment, certain tests may be performed to ensure ideal effectiveness.

  • 5

    End of Treatment

    At the end of the treatment cycle, patients discuss the current state of their cancer with their doctor. They are able to offer insights into the success of their chemotherapy treatment. They’ll also discuss their future prognosis.

    Patients may also learn about additional treatment suggestions from their oncologist. Follow-up visits usually take place between 2 and 6 weeks after treatment. These visits ensure that the cancer does not have a chance to redevelop. Visits decrease in frequency after a series of successful tests and treatments.

Improving Chemotherapy

There are clinical trials being conducted to study chemotherapy and the effectiveness of different drugs on mesothelioma. Some studies are continuing to investigate traditional chemotherapy methods, such as a trial studying the combination of oxaliplatin and gemcitabine.

Some research is using chemotherapy to improve novel treatments. Doctors and scientists have found that even when chemotherapy doesn’t have a significant impact. For instance, chemotherapy may weaken cancer cells, making it easier for other drugs to kill mesothelioma cells. Chemotherapy may even be used to slow down the immune system for treatment to be more effective.

Making Immunotherapy More Effective

Immunotherapy treatments are on the rise, and there are several clinical trials investigating these drugs. They are developed to employ the patient’s own immune system to attack mesothelioma cells. However, sometimes the patient’s immune system can attack the immunotherapy drug itself and prevent it from having an effect. A phase I clinical trial conducted by specialist Dr. Raffit Hassan found that using chemotherapy to suppress the immune system made the experimental drug SS1P far more effective. Participants in the study experienced major tumor regression.

Oxaliplatin and Gemcitabine Trial

These two drugs inhibit the growth of DNA. When combined, overall survival of mesothelioma patients can last up to 50 months. Patients who are involved in these clinical trials are given gemcitabine for 90 minutes and an oxaliplatin for two hours every 14 days. Patients are routinely offered 6 cycles of this chemotherapy. It is used for patients that have peritoneal and pleural mesothelioma with any cell type makeup. This clinical trial is being performed at Columbia University and is being led by Dr. Robert Taub.

How Can I Improve My Prognosis With Chemotherapy?

There are a multitude of chemotherapy drugs available to mesothelioma patients and even more combinations available. The best way for patients to access these drugs is through an experienced specialist. Clinical trials may also prove to be beneficial. They often provide options that aren’t typically available to patients with your diagnosis, which is beneficial for patients with limited options. Let our patient advocates connect you with recruiting clinical trials and mesothelioma specialists through our free Doctor Match program.