Chemotherapy is the standard 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.

  • Non-invasive

    Chemotherapy treatment is often non-invasive, meaning surgery is not necessary for its success. Many mesothelioma patients are not eligible for surgery but are eligible for chemotherapy.

Chemotherapy Basics

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

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.

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 on another. The goal is to do the most damage to the cancer cells while protecting the patient’s health.

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. Clinical trials are the best way to access novel chemotherapy drugs.

The combination of Alimta and cisplatin is the standard, and most common, chemotherapy treatment for mesothelioma.

Other chemotherapy drugs include:

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

Jill Litton

Portrait of 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 treatments. Surgery and chemotherapy 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.

Side Effects

Chemotherapy side effects are a major concern for patients considering the treatment. Drug prescriptions may be altered if the patient experiences adverse side effects.

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.

Common Side Effects

  • Hair loss
  • Nausea, vomiting, and constipation
  • Fatigue
  • Higher infection risk
  • Bruising and bleeding
  • Sore mouth
  • Delayed nausea and flu-like symptoms (often 2-5 days after treatment)
  • Peripheral neuropathy
  • Hearing loss

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.

Tips For Dealing With Side Effects

  • Notify your doctor – Be honest with medical staff about your side effects. Your doctor may be able to prescribe medicine for some of your symptoms, such as nausea medication. If the medical team that is caring for you are aware of your symptoms they can do their best to alleviate them.
  • Avoid infection – Chemotherapy can raise your risk of infection. Take care to avoid germs by staying away from people who are sick and contagious, washing your hands often, and being careful to cook foods thoroughly. It also may be helpful to rinse your mouth with baking soda or salt and water to flush bacteria from your mouth.
  • Prevent nausea – It may be difficult to eat during and after chemotherapy but you will need enough protein and calories to keep your weight up. Try eating smaller meals more frequently. Foods that may help include ginger and ginger flavored products, lemon drops, and cold foods. Avoid strong smelling foods and spicy foods.

What Causes Chemotherapy Side Effects?

Chemotherapy drugs work by targeting cells that divide quickly, such as cancer cells. Many side effects occur because chemo can affect other quickly dividing cells, such as bone marrow cells, which are important for creating blood cells. Many common side effects are caused by low blood cell counts, including white blood cells, red blood cells, and blood platelets. Chemo may also affect hair follicles and cells in the lining of the mouth and intestines.

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 is also used in conjunction with 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.

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 answers to any of their questions.
    During the visit, patients are examined fully. Blood work is done so that doctors will have a baseline of the patient’s health. The oncologist may consult with a multimodal team (such as surgeons or radiation oncologists) to offer opinions. Initial consultations give the patient a solid understanding of their treatment plan.

  • 2

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

    Doctors will prescribe drugs and vitamins to help prevent side effects including: vitamin B12, folic acid, corticosteroid, and antiemetic.

  • 3

    Receiving Treatment

    Most chemotherapy treatments are given in a comfortable setting and supervised by a chemotherapy nurse. Treatment time varies by case, and is on average administered every 3 weeks. Most patients receive 3-4 rounds. A common mesothelioma chemotherapy treatment includes 10 minutes of Alimta, 30 minutes to rest, and then 2 hours of cisplatin. During treatment, certain tests may be performed to ensure ideal effectiveness.

  • 4

    After Treatment

    Patients will have follow up visits with their doctor beginning a few weeks after their chemotherapy treatment ends. The doctor will offer insights into the success of the treatment and discuss the patient’s future prognosis.They may also offer additional treatment suggestions. Continued follow ups help doctors to treat their patient accordingly if the cancer regresses, progresses, or stays the same. Visits may decrease in frequency if patients continue to receive 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.

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.

Three Drug Chemotherapy: Alimta, Cisplatin, Bevacizumab

The current standard of care for pleural mesothelioma is chemotherapy with Alimta and cisplatin. Researchers believe adding a third chemo drug may improve effectiveness. In a clinical trial, patients who received all three drugs had an average overall survival of 2.7 months longer than patients who received only Alimta and cisplatin. The 3 drug combination is now included in the National Comprehensive Cancer Network guidelines as a first-line treatment option for mesothelioma patients.

Making Immunotherapy More Effective

Several clinical trials are investigating immunotherapy treatments. Many of these trials also employ chemotherapy. Immunotherapies are meant to work with the patient’s 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. One reason researchers will also prescribe chemotherapy is to suppress the immune system, keeping it from attacking the treatment.

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 clinical trials. They often provide options that aren’t available to all patients yet. Let our patient advocates connect you with recruiting clinical trials and mesothelioma specialists through our free Doctor Match program.