Written By: Devin Golden

Chemotherapy for Malignant Mesothelioma

Chemotherapy is a first-line treatment for patients with mesothelioma. It’s an option before, during or after surgery, or in cases when surgery isn’t possible. This treatment method is also considered the baseline for survival and safety when the FDA considers approving new therapies for mesothelioma.

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 Mesothelioma Chemotherapy

  • Chemotherapy for mesothelioma is one of the few approved treatment options by the U.S. Food and Drug Administration (FDA). The combination of cisplatin and pemetrexed is approved for malignant mesothelioma.
  • Pemetrexed and cisplatin have a median survival of 12 months for pleural mesothelioma. The median survival is a few months higher for peritoneal mesothelioma. The two drugs are used together due to improved survival compared to when either is used alone.
  • Other uses of chemotherapy — such as intraoperative chemotherapy, systemic chemotherapy before or after surgery, or chemotherapy with radiation — can improve survival by multiple years.
  • When surgery is possible, specialists will use chemotherapy as a second-line treatment to shrink tumors or prevent postoperative recurrence.
  • There are different chemotherapy drugs, types of chemotherapy and side effects applicable to mesothelioma cases.

What Is Malignant Mesothelioma Chemotherapy?

Mesothelioma chemotherapy is a cancer-killing treatment option for patients. It’s intended to target cells growing and dividing quicker than normal, such as diseased mesothelial cells. 

When mesothelioma forms, it grows and spreads by replicating at a rapid pace. Chemotherapy can destroy cancer cells and prolong a patient’s life.

Chemotherapy involves delivering cytotoxic (anti-cancer) drugs, or chemicals, into the body. Traditionally, these drugs are administered through an IV drip into the vein. The drugs travel through the bloodstream to areas where rapid cell growth is occurring. Chemotherapy prevents them from replicating at a rapid pace and causes the cancer cells to die.

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

Is Mesothelioma Chemotherapy Approved by the FDA?

In 2004, the FDA approved cisplatin and pemetrexed for malignant mesothelioma. Multiple studies showed the two drugs work better together than individually to prolong survival for mesothelioma patients.

Cisplatin is a platinum-based chemotherapy drug, often going by the brand name Platinol. It’s in the alkylating agent class of chemotherapy drugs.

Pemetrexed is the generic name for Alimta. It’s an antifolate antineoplastic agent.

In 2020, the FDA approved an injection form of pemetrexed for mesothelioma. The treatment became available in 2022 for patients who will not have surgery.

According to the U.S. National Library of Medicine, the pemetrexed injection is a liquid administered into a vein for around 10 minutes and usually once every three weeks. This administration requires much less time than standard chemotherapy (usually around 30 minutes to one hour).

How to Get Chemotherapy Treatment for Mesothelioma

If you have mesothelioma and want to begin chemotherapy treatment, follow these three steps on how to get chemotherapy for mesothelioma:

  1. After a diagnosis, contact a mesothelioma specialist to learn about your treatment options. You might be a candidate for surgery, which has longer survival times than chemotherapy alone.
  2. Research the chemotherapy drugs used for mesothelioma. Research the side effects and determine if this is the proper step to take in fighting your cancer and maintaining your quality of life.
  3. Plan your treatment with a specialist. Chemotherapy involves infusion cycles, or rounds, which usually occur 21 days apart. Talk to your doctor about how long each cycle lasts and how often you’ll receive treatment.

Types of Chemotherapy for Mesothelioma Treatment 

Intravenous chemotherapy is the main type of mesothelioma chemotherapy. It’s also called systemic chemotherapy. It involves delivering chemotherapy medications through an IV into a vein or port. The drugs travel through the bloodstream.

Another type of mesothelioma chemotherapy is chemoperfusion. The primary version of this is heated intraoperative chemotherapy. Doctors deliver liquid chemotherapy through a port into the site of surgery (either the chest or abdominal cavity).

For pleural mesothelioma, this is called hyperthermic intrathoracic chemotherapy (HITHOC). For peritoneal mesothelioma, this is called hyperthermic intraperitoneal chemotherapy (HIPEC).

Other types of mesothelioma chemotherapy are:

  • Systemic injection
  • Dwell chemotherapy
  • Oral chemotherapy
  • Spray chemotherapy

Dwell chemotherapy leaves the treatment in the patient’s body and continues delivering the treatment through catheters, or ports. These ports allow patients to receive hot chemotherapy after surgery and then have the treatment drained from their abdomen or lung cavity.

Oral chemotherapy for mesothelioma is in testing. The oral chemotherapy drug is olaparib, sold under the brand name Lynparza. The clinical trial is at the University of Chicago Medicine. Patients receive the drug every two weeks and in 28-day cycles.

Spray chemotherapy, or pressurized intraperitoneal aerosol chemotherapy (PIPAC), is the least common type of chemotherapy.

A study in France used it for peritoneal mesothelioma to see if patients could have cytoreduction/HIPEC surgery afterward. In the study, 13 patients received chemotherapy spray and all of them had surgery after. The average progression-free survival for the patients was 33.7 months.

Multimodal Therapies With Chemotherapy for Mesothelioma

Multimodal therapy is the use of different treatment options. Mesothelioma chemotherapy is often part of a multimodal approach to treating this cancer. 

Chemotherapy can be used before or after surgery. This is the multimodal option with the best survival rates.

The FDA approved a tumor treating fields device, Optune Lua, for malignant pleural mesothelioma. It must be used with systemic chemotherapy.

Other combinations of mesothelioma multimodal therapy include chemotherapy and:

  • Immunotherapy
  • Radiation therapy
  • Photodynamic therapy

Prepare for Chemotherapy

Patients should prepare for chemotherapy treatment. This involves planning for side effects, coordinating with caregivers and prioritizing their health. 

Before going to the hospital for treatment, patients should:

  • Make arrangements for help at home, such as a family member or friend assisting with household chores or personal care needs
  • Prepare meals well in advance
  • Research possible side effects
  • Get plenty of sleep the days leading up to treatment

After mesothelioma chemotherapy treatment, you’ll speak with a nurse or another medical team member about what to expect next. They may provide medication to reduce nausea and discuss other common side effects. You should:

  • Avoid people with colds or infections, as chemotherapy weakens your body’s immune system
  • Drink plenty of fluids, especially water, for the next few days to minimize side effects and flush the body of chemotherapy toxins
  • Eat small, frequent meals
  • Take walks and exercise when possible
  • Get plenty of rest

Talk with your doctor or oncologist about these tips and what else is recommended following your chemotherapy treatment.

Steps of Mesothelioma Chemotherapy

There are a few steps to receiving mesothelioma chemotherapy. These steps may change depending on the type of chemotherapy. The most common types are intravenous chemotherapy and heated intraoperative chemotherapy. They’re the two outlined in the steps below:

  1. Testing — Before starting treatment, patients undergo blood tests to ensure they’re a good candidate for chemotherapy. These tests reveal the patient’s overall health and health of certain organs, such as the liver and kidneys. Patients may get their blood pressure, pulse, respiratory rate and temperature checked.
  2. Preparation — For intravenous chemotherapy, a nurse inserts a catheter into the patient’s arm or implanted port. If the patient undergoes heated intraoperative chemotherapy, they receive two ports/catheters in either their abdomen or chest during surgery.
  3. Delivery — Chemotherapy is delivered into the patient’s body, either through the IV or port. Intravenous chemotherapy delivers drugs through an IV drip and typically takes 30-45 minutes. Heated intraoperative chemotherapy sends drugs through ports/catheters and takes longer, as the patient is rocked side to side to ensure the distribution of the therapy. The tumors are exposed to chemotherapy for an extended amount of time.
  4. Removal of catheter/ports — The medical staff removes the delivery method from the patient’s body, either the IV catheter or intraoperative ports/catheters. This signals the end of the chemotherapy session.
  5. Post-treatment review/monitoring — A medical team member monitors the patient’s blood pressure, pulse, breathing and temperature. If intravenous chemotherapy was used, they may check the blood count to record the levels of red and white blood cells. After intraoperative chemotherapy, the patient remains in the hospital for postoperative recovery.

Intravenous chemotherapy usually occurs in 21-day cycles. Patients receive the treatment on the first day of each cycle. The number of cycles may vary for different cases. So patients go through the above steps once every 21 days.

Steps of Dwell Chemotherapy for Mesothelioma

Some mesothelioma specialists use dwell chemotherapy, which is different from intravenous chemotherapy. These are the steps for cases using dwell chemotherapy:

  1. The medical team leaves the ports in the patient following heated intraoperative chemotherapy and surgery.
  2. Some patients receive EPIC, or “early postoperative intraperitoneal chemotherapy.” This usually occurs a few days after surgery, when the patient is likely still in recovery at the hospital.
  3. Patients then return weeks after surgery for continuous dwell chemotherapy treatment. This type of dwell chemotherapy is called NIPEC, or normothermic intraperitoneal chemotherapy.
  4. Doctors deliver the drugs into the chest or abdominal cavity, where they remain for several hours. Patients usually stay in the hospital for a few days consecutively to receive the intraperitoneal chemotherapy treatment numerous times with a long dwell time.

Side Effects of Chemotherapy for Mesothelioma Patients

Like chemotherapy for lung cancer or other types of cancer, chemotherapy for mesothelioma may cause side effects. There are nearly 50 potential side effects of chemotherapy. Some are manageable and mild, while others can be severe and cause serious complications.

Some of the chemotherapy side effects for mesothelioma are:

  • Nausea and vomiting
  • Body aches
  • Fatigue
  • Changes to taste
  • Loss of weight and appetite

Chemotherapy drugs may also lead to more severe side effects:

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

Eating more meals in smaller portions, taking regular naps, avoiding fatty foods, and exercising regularly are just a few ways to minimize these side effects.

Antiemetic drugs have been tested to reduce specific side effects, such as nausea and vomiting. Doctors may recommend patients take these medications if patients are struggling to manage their chemotherapy treatment.

Chemo Brain from Mesothelioma Chemotherapy

Another main side effects is called “chemo brain.”

Chemo brain is the mental clouding or fogginess that a patient may experience. This side effect can happen during or after treatment.

This fogginess occurs due to body and mental fatigue. However, studies suggest that chemotherapy may temporarily reduce cell growth in areas of the brain that control our learning and memory.

The effects of chemo brain include:

  • Decreased short-term memory
  • Trouble finding words
  • Short attention span
  • Difficulty concentration
  • Problems multitasking

Typically symptoms of chemo brain will improve within 9 to 12 months. However, there is a chance that individuals may have long-term effects. Some of the ways to prevent or overcome chemo brain include:

  • Mental challenges and games (crossword puzzles or Wordle, for instance)
  • Mental rehearsal (repeating words or ideas to help remember them)
  • Writing thoughts or tasks down (as to help remember them)

Chemotherapy Drugs Used for Mesothelioma

The top chemotherapy drugs for mesothelioma are cisplatin and pemetrexed. They’re the only two approved by the FDA for this cancer.

Other mesothelioma chemotherapy medications used experimentally or as substitutes are:

  • Carboplatin
  • Gemcitabine
  • Vinorelbine

Carboplatin is usually a substitute for cisplatin. It can help some patients with side effects. Gemcitabine and vinorelbine are experimental chemotherapy drugs. The above three are typically used for pleural mesothelioma.

For peritoneal mesothelioma, the main treatment is cytoreductive surgery with heated intraperitoneal chemotherapy. For this doctors may use the chemotherapy drugs doxorubicin and mitomycin.

Mesothelioma Chemotherapy Survival Rates

The average survival time for standard (systemic) mesothelioma chemotherapy on its own is 12-17 months. The variance depends on patient selection, the type of mesothelioma and more. 

Doctors have begun administering a combination of drugs to achieve improved survival rates for mesothelioma. The most common pairing is pemetrexed and cisplatin. A study published in the Journal of Thoracic Disease reported a median survival of 12 months for systemic cisplatin and pemetrexed. Patients receiving cisplatin without pemetrexed had a median survival of nine months.

Peritoneal mesothelioma has a slightly better survival rate with systemic chemotherapy. One study reported a median survival of 17 months for patients who received only this treatment.

Mesothelioma survival rates usually increase for intraoperative chemotherapy, or when systemic chemotherapy is part of multimodal treatment. These statistics were compiled from various studies:

  • 16 months median survival for systemic chemotherapy before or after pleural mesothelioma surgery
  • 22 months median survival for HIOC plus pleurectomy with decortication for pleural mesothelioma
  • 35 months median survival for surgery, photodynamic therapy and systemic chemotherapy for pleural mesothelioma
  • 53 months median survival and 47% five-year survival rate for HIPEC with cytoreductive surgery for peritoneal mesothelioma

Frequently Asked Questions About Mesothelioma Chemotherapy

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Does chemotherapy work for mesothelioma?

Chemotherapy can increase survival, diminish symptoms and improve quality of life. Doctors have not found a cure for mesothelioma, but chemotherapy is one of the few options proven to help people with this rare cancer.

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What type of chemotherapy is used for mesothelioma?

The two main types of chemotherapy for mesothelioma are systemic (intravenous) and intraoperative. Systemic chemotherapy is the well-known approach where doctors administer the drugs into the vein. Intraoperative is a more modern approach where doctors deliver the drugs, usually heated, in liquid form directly into the tumor environment.

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Which chemotherapy drugs are used for mesothelioma?

Pemetrexed and cisplatin are approved by the U.S. Food and Drug Administration for mesothelioma. When paired together, they increased survival by four months compared to only taking cisplatin. Some patients respond better to carboplatin than cisplatin. Other chemotherapy drugs used in studies are:

    • Vinorelbine
    • Gemcitabine
    • Doxorubicin
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How long does chemotherapy last?

Chemotherapy takes 2-3 hours for the systemic intravenous method. Intraoperative chemotherapy is usually 1-2 hours. Systemic chemotherapy is broken up into 2-6 “rounds” or “cycles.” Each cycle takes approximately 21 days. The number of cycles depends on the stage of the cancer and how well a patient handles treatment.

Sources & Author

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Devin Golden

About the Writer, Devin Golden

Devin Golden is the senior content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.