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Chemotherapy for Malignant Mesothelioma

Chemotherapy is a frequently used treatment for mesothelioma. It is a treatment option that can be given to patients before, during or after surgery, or in cases when surgery isn’t possible. This treatment is considered the baseline for survival and safety when the FDA considers approving new therapies for mesothelioma.

Medically reviewed for accuracy by

Dr. Stephen Williams

Precision Oncology Scientist

AI Summary of Chemotherapy for Malignant Mesothelioma

Chemotherapy for malignant mesothelioma is an important treatment option that aims to eliminate or control cancer cells in the body. It is often used to improve the chances of extending survival, either on its own or as part of a combination therapy that includes surgery or radiation. The most common and FDA-approved chemotherapy drugs for mesothelioma are cisplatin and pemetrexed. These drugs work by targeting rapidly dividing cancer cells, with cisplatin interfering with their DNA and pemetrexed inhibiting crucial processes for cell growth. The combination of these drugs has been shown to increase median survival times compared to using either drug alone.

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 drug combination of cisplatin and pemetrexed is approved to treat mesothelioma.
Pemetrexed and cisplatin have a median survival of 12 months for pleural mesothelioma. The median survival is slightly higher for peritoneal mesothelioma. This drug combination has led to improved survival compared to monotherapy with either pemetrexed and cisplatin 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?

Chemotherapy is a treatment option designed to eliminate cancer cells, particularly those that grow and divide more rapidly than normal, such as diseased mesothelial cells in mesothelioma.

When mesothelioma develops, it spreads by diseased cells replicating at an accelerated rate. Chemotherapy works to destroy these cancer cells and can help to extend a patient’s life.

This treatment involves the use of cytotoxic (anti-cancer) drugs, which are typically administered intravenously through an IV drip. Once in the bloodstream, these drugs target areas of rapid cell growth, disrupting the replication process and causing cancer cells to die.

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

Is Mesothelioma Chemotherapy Approved by the FDA?

In 2004, the FDA approved cisplatin and pemetrexed for malignant mesothelioma. There are several studies using pemetrexed in combination with cisplatin that demonstrate a prolonged survival in mesothelioma patients.

Cisplatin, commonly known by its brand name Platinol, is a platinum-based chemotherapy drug. It belongs to the alkylating agent class, which is a group of drugs that interfere with the DNA of cancer cells, preventing them from growing and dividing.

Pemetrexed, sold under the brand name Alimta, is a chemotherapy drug classified as an antifolate antineoplastic agent. This means it works by inhibiting the production of folate, a vitamin essential for DNA and RNA synthesis in rapidly dividing cells. By disrupting this process, pemetrexed prevents cancer cells from growing and multiplying, ultimately leading to their destruction.

APPROVAL OF NEW TREATMENT FOR MESOTHELIOMA

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

According to the U.S. National Library of Medicine, the pemetrexed injection is administered for 10 minutes and repeated once every three weeks. This administration requires much less time than standard intravenous chemotherapy (usually lasting at least one hour).

How to Get Chemotherapy Treatment for Mesothelioma

If you have been diagnosed with mesothelioma and are considering chemotherapy treatment, follow these three steps to find the best treatment options:

After receiving a diagnosis, contact a mesothelioma specialist to learn about your treatment options. You might be a candidate for surgery, which can provide longer survival than chemotherapy alone.

Research the chemotherapy drugs used for mesothelioma. Learn more about chemotherapy, the risks, the benefits, and the potential side effects. Discuss all the details with your mesothelioma specialist. The doctor will help you determine if this is the right choice to fight your mesothelioma and maintain your quality of life.

Plan your treatment with a specialist. Chemotherapy involves infusion cycles, or rounds, which usually occur once every 3 weeks with a rest period in between. Your doctor will develop a treatment plan to determine how many cycles you will need.

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Types of Chemotherapy for Mesothelioma Treatment

Intravenous chemotherapy, also called systemic 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 to find and kill cancer cells.

ADDITIONAL METHODS OF CHEMOTHERAPY

Another type of mesothelioma chemotherapy is chemoperfusion. The primary version of this is heated intraoperative chemotherapy. Doctors deliver a liquid chemotherapy solution through a port into the site of surgery (either the chest or abdominal cavity). This approach allows for higher concentration of the drug to be delivered to the tumor site while minimizing exposure to the rest of the body, which reduces systemic side effects.

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 is similar to the HIPEC, where chemotherapy drugs are delivered directly into the chest or abdominal cavity. The ports for dwell treatment are placed in surgery but left in place for extended periods of time. This allows doctors the ability to deliver localized chemotherapy continuously or in cycles for days, weeks or months after surgery.

Oral chemotherapy for mesothelioma is currently under investigation, with one promising drug being Olaparib, marketed under the brand name Lynparza.

A clinical trial at the University of Chicago Medicine is testing the effectiveness and safety of olaparib for mesothelioma patients. Participants receive the drug orally every two weeks, with treatment cycles spanning 28 days. The trial aims to evaluate how well the drug controls tumor growth, its potential to improve survival rates, and the tolerability of side effects.

Spray chemotherapy, or pressurized intraperitoneal aerosol chemotherapy (PIPAC), is another type of chemotherapy being studied in clinical trials.

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 a combination of treatment options used to achieve optimal results. Mesothelioma chemotherapy is often part of a multimodal approach to treating this rare cancer.

Chemotherapy can be used before or after surgery. This multimodal option has presented improved survival rates.

The FDA approved Optune Lua, which is a tumor treating fields device that sends electrical waves, or fields, through the chest to kill cancer cells. This mesothelioma treatment is FDA-approved when paired with systemic chemotherapy.

Other combinations of mesothelioma multimodal therapy pair chemotherapy with:

Immunotherapy

Radiation therapy

Photodynamic therapy

Prepare for Mesothelioma Chemotherapy

Receiving mesothelioma chemotherapy involves planning and preparation. Understanding and planning for potential side effects, the possible need for caregivers, and prioritizing healthy habits can set yourself up for success.

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

The doctor, nurse or another member of the medical team will provide the information you need to fully prepare you for your mesothelioma chemotherapy treatment. It is important to take notes, ask questions and understand what to expect.

After the mesothelioma chemotherapy treatment, the nurse will explain possible side effects and instruct you to call the doctor with any new or worsening symptoms or side effects. Many of the symptoms and side effects from chemotherapy can be managed, but the medical team must be alerted right away.

Chemotherapy can weaken the body’s immune system. Important things to know are:

Be cautious in public and around people with colds or infections
Drink plenty of fluids after chemotherapy, especially water, to maintain hydration, minimize side effects, and flush the body of the toxins from the treatment
Eat small, frequent meals, and focus on nutritional foods and snacks
Mobility is important, as walking and light exercises can improve mood and energy levels
Give yourself time to rest and recover

Talk with your doctor about post-treatment precautions, recommendations, and when to report changes or concerns.

Steps of Mesothelioma Chemotherapy

There are a few steps to receiving mesothelioma chemotherapy. These steps may change depending on the type of chemotherapy:

Testing

Before starting treatment, patients undergo blood tests to ensure they are 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 also have their vital signs monitored, such as blood pressure, pulse, respiratory rate and temperature.

Preparation

For intravenous chemotherapy, a nurse inserts a catheter into the patient’s arm or implanted port. If the patient is receiving heated intraoperative chemotherapy, the two ports/catheters are inserted into their abdomen or chest during surgery.

Delivery

Chemotherapy is delivered into the patient’s body, either through the IV or port. Intravenous chemotherapy delivers drugs through an IV drip and can last up to an hour. The total infusion time may be longer depending on other IV medications or hydration needed for the treatment. Heated intraoperative chemotherapy is administered through ports/catheters, 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.

Removal of catheter/ports

The medical staff removes the delivery method from the patient, either the IV catheter or intraoperative ports/catheters.

Post-treatment review/monitoring

A nurse monitors the patient closely after treatment. The patient’s blood pressure, pulse, breathing and temperature are all evaluated for any changes. If intravenous chemotherapy was used, they may check the blood count to record the levels of red and white blood cells. After surgery with intraoperative chemotherapy, the patient remains in the hospital for postoperative recovery.

Intravenous chemotherapy is typically given once every 3 weeks with a rest period in between. The number of cycles may vary for each patient.

Steps of Dwell Chemotherapy for Mesothelioma

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

The medical team leaves the ports in the patient following surgery with heated intraoperative chemotherapy.

Some patients receive EPIC, or “early postoperative intraperitoneal chemotherapy.” This usually occurs a few days after surgery, when the patient is likely still recovering in the hospital.

Patients may be required to stay in the hospital for a few days after they receive this treatment.

NIPEC, or normothermic intraperitoneal chemotherapy, is a form of dwell chemotherapy where the chemotherapy drugs are not heated (like with HIPEC). With this therapy, the patient will return to the medical facility weeks after surgery to have chemotherapy delivered in the chest or abdominal cavity. The length of this procedure may vary depending on the patient and type of chemotherapy ordered by the doctor.

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:

Body aches

Mouth sores

Fatigue

Changes
to taste

Nausea
and vomiting

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 smaller portions more often, taking regular naps, avoiding fatty foods, and regular light exercise are just a few ways to minimize these side effects.

Antiemetic drugs, which are drugs that reduce nausea and vomiting, are often prescribed for patients receiving chemotherapy. Doctors may recommend patients take these medications as a preventative measure to avoid nausea and vomiting, which can lead to more serious complications like weight loss, weakness and malnutrition.

Chemo Brain from Mesothelioma Chemotherapy

“Chemo brain” refers to cognitive changes that some people experience during or after chemotherapy treatment. It often involves difficulties with memory, concentration, multitasking, and processing information.

While the exact cause isn’t fully understood, it’s thought to result from a combination of chemotherapy effects, fatigue, stress, and other factors. Symptoms can vary in severity and duration, with most improving over time. Strategies like mental exercises, organization tools, and lifestyle adjustments can help manage the condition.

THE EFFECTS OF CHEMO BRAIN

Decreased short-term memory
Trouble finding words
Decreased attention span
Difficulty concentrating
Problems multitasking

Symptoms of chemo brain often improve within 9-12 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)
Memory exercises (repeating words or ideas to help remember them)
Taking notes, journaling, or making lists

Chemotherapy Drugs Used for Mesothelioma

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

Other mesothelioma chemotherapy medications used in clinical trials or as substitutes are:

Carboplatin
Gemcitabine
Vinorelbine

Carboplatin is often a substitute when patients have a reaction to cisplatin. It can help some patients with side effects. Gemcitabine and vinorelbine are still under investigation and testing. These chemotherapy drugs are used for pleural mesothelioma.

For peritoneal mesothelioma, the combination of cisplatin and pemetrexed is used as a systemic chemotherapy treatment. When surgery is a treatment option, doctors may opt for the chemotherapy drugs doxorubicin and mitomycin during cytoreductive surgery with heated intraperitoneal chemotherapy. For this, doctors may use the chemotherapy drugs doxorubicin and mitomycin.

Learn More About Each Chemotherapy Drug

Mesothelioma Chemotherapy Survival Rates

The average survival for patients treated with standard (systemic) mesothelioma chemotherapy on its own is 12-17 months. The variance depends on factors such as patient selection and the type of mesothelioma.

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 9 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.

HOW CHEMOTHERAPY AFFECTS SURVIVAL RATES

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 heated intraoperative chemotherapy 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

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Frequently Asked Questions About Mesothelioma Chemotherapy

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 option proven to help people with this rare cancer.

What type of chemotherapy is used for mesothelioma?

The 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 chest or abdominal cavity, where tumors develop.

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 clinical studies are:

Vinorelbine
Gemcitabine
Doxorubicin

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 “rounds” or “cycles.” Each cycle is given once every 3 weeks with a rest period in between treatment. The number of cycles depends on the stage of the cancer and how well a patient handles treatment.

Sources & Author

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About the Writer, David Statman

David Statman is a Content Writer for Mesothelioma Guide. He received both his bachelor's and master's in journalism from West Virginia University, and has been in medical publishing since January 2022. He previously worked in sports journalism, primarily reporting on West Virginia sports for a number of publications.

He lives in Delaware with his wife, dog and two cats, and avidly competes as a professional wrestler in the Philadelphia area.