Written By: David Statman
Mesothelioma Chemotherapy Drugs
Chemotherapy for mesothelioma is a standard of care for people with this cancer. There are several mesothelioma chemotherapy medications, although only two are approved by the U.S. Food and Drug Administration (FDA). These drugs are best used as a combination to improve survival.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Important Facts About Mesothelioma Chemotherapy Medications
- The combination of pemetrexed and cisplatin is approved by the FDA for malignant mesothelioma.
- Other chemotherapy drugs for mesothelioma include vinorelbine and gemcitabine.
- Common side effects from chemotherapy drugs can include nausea, fatigue, and low blood counts. Patients should immediately report any side effects to their doctor.
Top Chemotherapy Drugs for Mesothelioma
There are five common chemotherapy drugs used for the treatment of mesothelioma. They are:
- Pemetrexed
- Cisplatin
- Carboplatin
- Vinorelbine
- Gemcitabine
Only pemetrexed and cisplatin are approved by the FDA for malignant mesothelioma. Carboplatin is approved as a substitute for cisplatin when needed.
Pemetrexed
Pemetrexed, which is the generic name for Alimta, is an antifolate antineoplastic chemotherapy agent that was approved by the FDA in 2004. It fights cancer cells by interfering with the use of folate to make DNA and RNA inside cancer cells, which is necessary for cell growth and division.
Doctors usually administer pemetrexed intravenously. In other cases, it may be used intraoperatively, as a heated chemotherapy solution placed directly into the chest or abdominal cavity.
Because pemetrexed works by interfering with the use of folate, it can also affect healthy cells that rely on folate for normal growth and repair. This may result in side effects such as nausea, fatigue and low blood cell counts. Doctors will often prescribe vitamin B12 and folic acid supplements to help reduce the risk of these side effects and protect against serious complications.
Cisplatin
Cisplatin, the generic name for Platinol, was FDA-approved in 2004 for the treatment of mesothelioma when given with pemetrexed. This platinum-based chemotherapy medication attacks cancer cells by damaging the DNA inside the cancer cells, preventing them from growing and dividing, resulting in cell death.
The drug is usually administered through an intravenous infusion. In other cases, it may be delivered intraoperatively as a heated solution.
Common side effects of cisplatin include nausea, vomiting, fatigue, kidney toxicity, and low blood cell counts. Doctors will closely monitor patients throughout their treatment regimen and provide supportive therapies to manage any side effects.
Carboplatin
Carboplatin is FDA-approved for the treatment of malignant mesothelioma as an alternative for cisplatin. It is often used in patients who cannot tolerate cisplatin and tends to be easier on the kidneys and nervous system.
Similar to cisplatin, carboplatin is a platinum-based agent. It attacks cancer cells by damaging their DNA and disrupting cell division.
Carboplatin is given intravenously or intraoperatively.
Gemcitabine
Gemcitabine, the generic name for Gemzar, is an experimental chemotherapy drug for malignant mesothelioma. It’s also used for the treatment of non-small cell lung cancers along with cancers of the breast, bladder, and pancreas.
Gemcitabine is an antimetabolite, meaning it disrupts the cells’ building blocks needed to make DNA, preventing cell growth and cell division. It is administered intravenously.
Vinorelbine
Vinorelbine, the generic name for Navelbine, is an experimental chemotherapy medication for malignant mesothelioma. It is also used for the treatment of non-small cell lung cancers.
Vinorelbine is a vinca alkaloid, which interferes with the microtubule structures within cancer cells. The drug prevents division and replication.
The drug is given intravenously. Aside from the usual side effects, vinorelbine can cause burning or swelling at the infusion site.
Chemotherapy Drug Combinations for Mesothelioma
The main chemotherapy combination used for the treatment of mesothelioma is pemetrexed and cisplatin. Another is pemetrexed and carboplatin. Survival rates have shown to improve when patients receive a combination of medications versus just one.
Cisplatin and Pemetrexed for Mesothelioma
Multiple studies report the combination of cisplatin and pemetrexed for mesothelioma has a median survival of 1 year. A 2008 study of hundreds of mesothelioma patients concluded a 4-month increase in survival for this combination compared to patients only taking cisplatin.
The recommended dose of pemetrexed is 500 mg/m, the dose is calculated on the patient’s body surface area (a calculation of the patient’s height and weight). Pemetrexed is often administered over approximately 10 minutes and repeated every 21 days.
The recommended dose of cisplatin is 75 mg/m, also calculated by body surface area. Cisplatin is often administered over approximately 2 hours on the same day as the pemetrexed.
Carboplatin and Pemetrexed
The combination of carboplatin and pemetrexed (a treatment regimen often chosen as an alternative to cisplatin and pemetrexed when needed) has a median survival of 12-14 months. One study reported 12.7 months and another reported 14 months.
Bevacizumab, Pemetrexed and Cisplatin
Bevacizumab, the generic name for Avastin, is an anti-angiogenic drug, meaning it disrupts the creation of new blood vessels (angiogenesis) that can feed tumors. Bevacizumab targets a growth protein in cancer cells.
Bevacizumab is a targeted therapy that can be combined with pemetrexed and cisplatin as a treatment for mesothelioma in select cases. According to a 2016 study, the median survival time for people with mesothelioma who received bevacizumab, pemetrexed, and cisplatin was 18.8 months.
Bevacizumab is administered intravenously.
Vinorelbine and Cisplatin
Vinorelbine and cisplatin is a combination therapy that is sometimes used to treat mesothelioma, when first-line treatments are no longer effective. A 2008 study of vinorelbine and cisplatin had a 1-year survival rate of 61% and a 2-year survival rate of 31%.
Pemetrexed and Gemcitabine
Gemcitabine and pemetrexed are chemotherapy drugs that work differently to attack cancer cell growth. The combination is sometimes used to treat mesothelioma in clinical trials and in later-line settings when other treatments were no longer effective or stopped due to complications or side effects . A 2015 study of non-small cell lung cancer patients found a median survival time of 15 months.
Frequently Asked Questions About Mesothelioma Chemotherapy Medications
What are the best chemotherapy drugs for mesothelioma?
Pemetrexed and cisplatin are the top chemotherapy drugs used for the treatment of malignant mesothelioma. They work best as a combination, with patients often surviving for 12-14 months when receiving this chemotherapy regimen.
Which chemotherapy drugs are FDA approved?
The FDA approved cisplatin and pemetrexed for pleural mesothelioma in 2004. Carboplatin is approved as a substitute for cisplatin.
What other chemotherapy drugs can be used to treat mesothelioma?
Vinorelbine and gemcitabine are experimental chemotherapy medications for mesothelioma. Bevacizumab is an anti-angiogenic drug that prevents the growth of blood vessels. It is sometimes given as a third drug with pemetrexed and cisplatin in select patients. The trio led to median survival of 18 months in mesothelioma cases.
Sources & Author
- FDA drug approval summaries: pemetrexed (Alimta). Oncologist. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/15477632/. Accessed: 06/11/2026.
- Phase II Study of Pemetrexed Plus Carboplatin in Malignant Pleural Mesothelioma. Journal of Clinical Oncology. Retrieved from: https://ascopubs.org/doi/10.1200/JCO.2005.04.3190. Accessed: 06/11/2026.
- Review of pemetrexed in combination with cisplatin for the treatment of malignant pleural mesothelioma. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503655/. Accessed:06/11/2026.
- Cisplatin and vinorelbine first-line chemotherapy in non-resectable malignant pleural mesothelioma. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453034/. Accessed: 06/11/2026.
- Pemetrexed and gemcitabine versus carboplatin and gemcitabine in non-small cell lung cancer: a randomized noninferiority phase II study in one center. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25732264. Accessed: 06/11/2026.
- Comparison of cisplatin plus pemetrexed and cisplatin plus gemcitabine for the treatment of malignant pleural mesothelioma in Japanese patients. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24636265. Accessed: 06/11/2026.
- Alimta Approval History. Drugs.com. Retrieved from: https://www.drugs.com/history/alimta.html. Accessed: 06/11/2026.
- Alimta. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/alimta.aspx. Accessed: 06/11/2026.
- Cisplatin. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/cisplatin.aspx. Accessed: 06/11/2026.
- Carboplatin. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/carboplatin.aspx. Accessed: 06/11/2026.
- Gemcitabine. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/gemcitabine.aspx. Accessed: 06/11/2026.
- Vinorelbine. Chemocare. Retrieved from: https://chemocare.com/druginfo/vinorelbine. Accessed: 06/11/2026.
- Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26719230?dopt=Abstract. Accessed: 06/11/2026.
- Avastin. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/avastin.aspx. Accessed: 06/11/2026.
AI Summary of Mesothelioma Chemotherapy Drugs
Chemotherapy drugs play a vital role in the treatment of mesothelioma, a rare and aggressive cancer typically caused by asbestos exposure. Several medications are used to target and destroy cancer cells, with the most common combinations improving patient survival and quality of life. Among these, the pairing of pemetrexed and cisplatin is the most widely approved and studied treatment option, giving hope to many patients and their families. These medications are administered intravenously and work by damaging the cancer cells' ability to grow and divide, thereby slowing or stopping the progression of the disease.
In addition to the standard drug combination, other chemotherapy medications are sometimes used based on individual patient needs and specific circumstances. These include drugs like carboplatin, which is often used as a substitute for cisplatin because it can reduce certain side effects, particularly to the kidneys. There are also experimental drugs such as gemcitabine and vinorelbine, which show promise in clinical studies but are not yet widely approved for routine treatment. These medications work by different mechanisms, such as disrupting the cells’ metabolism or preventing cell division, to attack the cancer from multiple angles. Patients should always discuss potential side effects with their healthcare team, as chemotherapy can cause nausea, fatigue, and other symptoms requiring supportive care.
Combining different drugs can improve a patient’s chances of longer survival, with research indicating that treatment regimens involving multiple medications tend to be more effective than single-drug therapies. For example, studies have shown that the combination of pemetrexed and cisplatin can extend median survival to around one year, and adding additional agents like bevacizumab may further enhance outcomes. While these treatments can be powerful, they also come with side effects, and careful monitoring is essential to ensure optimal care. Overall, chemotherapy offers a critical approach to managing mesothelioma, aiming to slow disease progression and improve patients' quality of life, often along with other treatment modalities."