Written By: Camryn Keeble

Pleural Mesothelioma Chemotherapy

Pleural mesothelioma chemotherapy is one of the most common treatment methods for people with this type of cancer. Chemotherapy can be administered before, during or after surgery, or as an alternative to surgery.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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Important Facts About Pleural Mesothelioma Chemotherapy

  • Two chemotherapy drugs, pemetrexed and cisplatin, are FDA-approved for malignant pleural mesothelioma treatment.
  • The FDA uses chemotherapy as the baseline for safety and survival when considering other mesothelioma therapies tested in clinical trials.
  • Chemotherapy is often used in multimodal treatment approaches, such as in combination with surgery, immunotherapy or radiation.

What Is Pleural Mesothelioma Chemotherapy?

Chemotherapy for pleural mesothelioma is a type of cancer-killing treatment. The goal is to attack cancer cells by preventing cell division, replication and growth.

When malignant pleural mesothelioma forms, diseased mesothelial cells grow and spread rapidly, starting in the thin lining around the lungs (the pleura). Chemotherapy drugs can target the diseased cells, killing them and extending the patient’s life.

Chemotherapy involves delivering cytotoxic (anti-cancer) drugs, or chemicals, into the body. In pleural mesothelioma treatment, it is most often administered intravenously, through an IV drip. This type is also called systemic chemotherapy.

The chemotherapy drugs travel through the bloodstream to areas of the body where cancer cells are developing. Chemotherapy interferes with the diseased cells’ ability to replicate and causes them to die.

Patients typically receive pleural mesothelioma chemotherapy at a local hospital, cancer center, outpatient medical clinic or infusion center. Chemotherapy is the most accessible pleural mesothelioma treatment.

Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Mesothelioma Icon

Hyperthermic Intrathoracic Chemotherapy (HITHOC) for Pleural Mesothelioma

Hyperthermic intrathoracic chemotherapy, also known as HITHOC or heated chemotherapy, is a type of chemotherapy involving heated liquid chemotherapy drugs. Mesothelioma treatment specialists use a mixture of heated chemotherapy drugs to bathe the thoracic cavity during surgery.

HITHOC is different from the standard method of delivering chemotherapy through an IV. Heated chemotherapy is delivered through tubing placed directly into the chest cavity, which gives the chemotherapy drugs direct access to the diseased tissue. The goal is to fill the chest cavity with heated chemotherapy, destroying any remaining mesothelioma cells not removed during surgery.

HITHOC’s delivery method minimizes the amount of chemotherapy entering the bloodstream and traveling to other parts of the body. This benefits patients by reducing the risk of chemotherapy attacking healthy tissue or blood cells, which can cause ongoing side effects such as nausea and fatigue.

FDA-Approved Chemotherapy for Pleural Mesothelioma

Chemotherapy for pleural mesothelioma was approved by the FDA in 2004. Pemetrexed and cisplatin are the two drugs approved for pleural mesothelioma. Multiple studies prove the two drugs work best when used together, prolonging survival for patients.

Cisplatin is a platinum-based chemotherapy drug, often called by the brand name Platinol. It’s classified as an alkylating agent, which keeps the cell from reproducing by damaging the cell’s DNA.

Pemetrexed is an antifolate antineoplastic agent, which blocks cancer cells from growing and spreading to other areas of the body. The brand name for pemetrexed is Alimta. 

In 2020, the FDA approved an injection form of pemetrexed for pleural mesothelioma treatment. The injection became available to patients ineligible for surgery in 2022.

According to the U.S. National Library of Medicine, the injectable form of pemetrexed is infused into a vein for approximately 10 minutes once every three weeks. This form of chemotherapy requires much less time than the standard chemotherapy treatment, which can take up to an hour.

Steps of Pleural Mesothelioma Chemotherapy

The process of receiving chemotherapy for pleural mesothelioma involves several steps, which can vary depending on the patient’s individual treatment plan. The chemotherapy success rate of administering the treatment is very high, as medical professionals have nearly perfected the process of delivering chemotherapy to patients through an IV.

Here are the steps of pleural mesothelioma chemotherapy through an IV:


Health screening — Before treatment can begin, patients must undergo blood tests and health screenings to ensure they’re a good candidate for chemotherapy. The blood tests and screenings will show the patient’s overall health and status of certain organs, such as the liver and kidneys.


Preparation — For pleural mesothelioma chemotherapy, many doctors will recommend placement of a port under the skin on the chest with an attached catheter fed into a large vein above the heart.


Delivery — Intravenous chemotherapy sends drugs through an IV drip and usually takes 30-45 minutes. Chemotherapy continues to circulate throughout the body even after the infusion is complete.


IV removal — The medical staff will typically remove the IV when the chemotherapy treatment session has completed. Sometimes the IV or port will remain accessible and secured for the next treatment session.

The medical team will monitor the patient’s blood pressure, pulse, heart rate and temperature before, during and after the infusion to ensure the patient is not experiencing any adverse reactions. If there are any concerns or reactions noted, they may check the patient’s blood work for any changes.

Side Effects of Pleural Mesothelioma Chemotherapy

Chemotherapy for pleural mesothelioma can have side effects. There are nearly 50 possible side effects that can range from mild to serious complications.

Some potential side effects of pleural mesothelioma chemotherapy include:

  • Nausea and vomiting
  • Fatigue
  • Loss of appetite
  • Body aches
  • Changes in taste (metallic)
  • Weight loss

Serious potential side effects of pleural mesothelioma chemotherapy include:

  • Itching and rashes
  • Bleeding
  • Damage to the liver, kidneys or heart
  • Increased risk of infection
  • Inflammation of digestive tract membrane linings

There are ways to minimize chemotherapy side effects, such as taking short naps regularly, avoiding fatty foods, drinking plenty of fluids, and participating in mild exercise. If patients are struggling with chemotherapy-related nausea and vomiting, doctors may recommend natural ginger or antiemetic medications.

Pleural Mesothelioma Chemotherapy Survival Rates

According to a study published in the Journal of Thoracic Disease, the median survival for pleural mesothelioma chemotherapy was reported as 12 months. Patients receiving cisplatin without pemetrexed had a median survival of nine months.

With these findings, doctors began combining the two chemotherapy drugs to improve survival.

HITHOC, the intraoperative type of chemotherapy for pleural mesothelioma, also improves survival. A study published in the Journal of Thoracic Disease demonstrated that people who received HITHOC during surgery had a median survival of 20.5 months, an increase of nearly four months compared to people who did not receive HITHOC.

Frequently Asked Questions About Pleural Mesothelioma Chemotherapy

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What Type of Chemotherapy Is Used for Pleural Mesothelioma?

There are two types of chemotherapy used to treat pleural mesothelioma: systemic and HITHOC (hyperthermic intraperitoneal chemotherapy). Systemic chemotherapy, the most common approach, is where doctors administer drugs by an IV drip. Hyperthermic intraperitoneal chemotherapy is where doctors deliver heated chemotherapy drugs directly into the chest cavity.

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What Chemotherapy Drugs Are Approved for Pleural Mesothelioma Treatment?

Pemetrexed and cisplatin are the two chemotherapy drugs approved by the U.S. Food and Drug Administration for pleural mesothelioma treatment. Studies prove that the two drugs can increase survival when paired together.

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Can Pleural Mesothelioma Be Treated with Chemotherapy?

Pleural mesothelioma chemotherapy can increase chances of survival, reduce symptoms, and improve quality of life. Mesothelioma specialists have not yet found a cure for mesothelioma, but chemotherapy can help people with pleural mesothelioma.

Sources & Author

  1. Chemotherapy for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/chemotherapy.html. Accessed: 07/20/2021.
  2. Cisplatin. Chemocare. Retrieved from: https://chemocare.com/chemotherapy/drug-info/PlatinolAQ.aspx. Accessed: 07/15/2021.
  3. Pemetrexed. Chemocare. Retrieved from: https://chemocare.com/chemotherapy/drug-info/PEMETREXED.aspx. Accessed: 07/20/2021.
  4. Normothermic intraperitoneal chemotherapy long term (NIPEC-LT) in the management of peritoneal surface malignancy, an overview. Pleura and Peritoneum. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405030/. Accessed: 07/28/2021.
  5. Pemfexy, a Ready-to-Dilute Formulation of Pemetrexed, Gets Final FDA Approval. MPR. Retrieved from: https://www.empr.com/home/news/pemfexy-a-ready-to-dilute-formulation-of-pemetrexed-gets-final-fda-approval/. Accessed: 02/10/2020.
  6. Tips for Managing Chemotherapy Side Effects. WebMD. Retrieved from: https://www.webmd.com/cancer/tips-for-managing-chemotherapy-side-effects. Accessed: 05/04/2021.
  7. Pemetrexed and cisplatin. Cancer Research UK. Retrieved from: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/pemetrexed-cisplatin. Accessed: 05/03/2021.
  8. Cisplatin + Pemetrexed (Alimta). ChemoExperts. Retrieved from: https://www.chemoexperts.com/cisplatin-pemetrexed-alimta.html. Accessed: 05/03/2021.
  9. What to Expect When Having Chemotherapy. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/what-expect-when-having-chemotherapy. Accessed: 07/21/2021.
  10. Chemotherapy. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/chemotherapy/about/pac-20385033. Accessed: 07/21/2021.
  11. How Is Chemotherapy Given? Chemocare. Retrieved from: https://chemocare.com/chemotherapy/what-is-chemotherapy/how-chemotherapy-is-given.aspx. Accessed: 07/21/2021.
  12. Latest mesothelioma life expectancy stats and survival rates. Biomed Central. Retrieved from: https://blogs.biomedcentral.com/on-health/2017/03/21/latest-mesothelioma-life-expectancy-stats-and-survival-rates/. Accessed: 07/28/2021.
  13. Treated with Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Plus Systemic Chemotherapy Could Lead to Secondary Complete Cytoreductive Surgery: A Cohort Study. Annals of Surgical Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/34713369/. Accessed: 11/02/2021.
  14. Tips for Managing Chemobrain. DANA-FARBER Cancer Institute. Retrieved from: http://www.dana-farber.org/health-library/articles/tips-for-managing-chemobrain/. Accessed: 10/03/2017.
  15. Chemo Brain. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/changes-in-mood-or-thinking/chemo-brain.html. Accessed: 10/03/2017.
  16. Chemotherapy treatment in malignant pleural mesothelioma: a difficult history. Journal of Thoracic Disease. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830568/. Accessed: 07/28/2021.
  17. Diaphragm and lung–preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience. Journal of Thoracic and Cardiovascular Surgery. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0022522317323991. Accessed: 07/22/2021.
  18. Malignant Mesothelioma of the Peritoneum in Women: A Clinicopathologic Study of 164 Cases. American Journal of Surgical Pathology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32769428/. Accessed: 07/22/2021.
  19. Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting. British Medical Journal. Retrieved from: https://academic.oup.com/bjsopen/article/4/2/260/6061334. Accessed: 07/22/2021.
  20. Malignant peritoneal mesothelioma: a review. Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497105/. Accessed: 07/22/2021.
  21. Olaparib in Patients With HRD Malignant Mesothelioma. Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT04515836. Accessed: 06/24/2021.
  22. Eagle Pharmaceuticals Receives Final FDA Approval for PEMFEXY™ (Pemetrexed for Injection). Yahoo Finance. Retrieved from: https://finance.yahoo.com/news/eagle-pharmaceuticals-receives-fda-approval-115000112.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALrUIS-FmG5tqGcjvLsri5G1qL2vIHfFj3gvv4VTUIMl_3Z1tZx55NVEf9RKDXvt6en_2C0kHD4LxY2rmmUkBdXJIYOwySyUGhr2otoE_HPFKnREgzO4KPZxClPCVYviuEJ1PSS-kmPTQYNDdS21oPVYcLR5NSTiDJAjzlU20e1g Accessed: 01/23/2024.
  23. Pemetrexed Injection. U.S. National Library of Medicine. Retrieved from: https://medlineplus.gov/druginfo/meds/a607043.html. Accessed: 02/10/2020.
  24. Impact of hyperthermic intrathoracic chemotherapy (HITHOC) during resection of pleural mesothelioma on patient survival. Journal of Thoracic Disease. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38090290/. Accessed: 01/22/2024.
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About the Writer, Camryn Keeble

Camryn Keeble is a content writer and editor for Mesothelioma Guide. She creates informative content to educate mesothelioma patients and their loved ones on news, treatments and more. She also works diligently to raise awareness of the dangers of asbestos exposure and the effects of mesothelioma.