Mesothelioma Chemotherapy

Mesothelioma chemotherapy is one of several treatment options for mesothelioma cancer. You may receive mesothelioma chemotherapy alone or in combination with surgery or radiation. It may be scary to hear your doctor say you need chemotherapy, but this is one of the most versatile and effective mesothelioma treatments.

While mesothelioma chemotherapy may have side effects that are difficult to deal with, it can also have great benefits. Studies have shown that mesothelioma patients who received chemotherapy survive two to four times as long as those who do not receive treatment.

Understanding Mesothelioma Chemotherapy

Chemotherapy, also called chemo, means treating disease (usually cancer) through drugs. If someone you know has gone through chemotherapy, you may know it as a harsh treatment with strong drugs.

Chemotherapy often does have unpleasant side effects. You may have a bad reaction to one or more chemotherapy drugs. There are many different mesothelioma chemotherapy options, so your doctor can give you a different drug if this happens to you.

In recent years, mesothelioma research has developed new drugs and new treatment protocols that have fewer side effects. You may find that today’s mesothelioma chemotherapy is not as bad as you imagined.

Mesothelioma is a cancer caused by asbestos exposure that develops in the mesothelium or lining around an organ. The most common mesothelioma type is pleural, affecting the lungs. Chemotherapy for mesothelioma works by killing off the rapidly growing cancer cells or stopping them from replicating. While mesothelioma chemotherapy can’t cure this cancer, it can slow the progress of the disease and prevent tumors from spreading to other parts of the body.

Chemotherapy may be used to provide relief for mesothelioma patients in all but the latest stages of the disease. Mesothelioma stages are an indication of how far the malignancy has advanced. In the early stages, the tumor is usually local and the disease is easier to treat. In later stages, malignant mesothelioma cells have spread to your lymph nodes or even metastasized to other organs in your body. If the cancer has spread widely through the body, mesothelioma chemotherapy side effects may outweigh the benefits. At that point, the best option may be palliative mesothelioma care: treatment for your symptoms to keep you comfortable.

Uses of Mesothelioma Chemotherapy

There are several different types of mesothelioma chemotherapy. Which treatment your doctor recommends for you will depend on your overall health, the location of your mesothelioma tumor, and the stage of your cancer.

Mesothelioma chemotherapy is often used with other treatments. Neoadjuvant therapy is given before surgery to shrink your tumor. Adjuvant therapy is given after mesothelioma surgery, to kill any stray cancer cells that the surgeon missed.

Some mesothelioma tumors can’t be surgically removed. In this case, chemotherapy and radiation can provide a one-two punch for your mesothelioma cancer. In some cases, chemotherapy may also be used as a standalone treatment.

Systemic Mesothelioma Chemotherapy

Systemic chemotherapy is given intravenously or in pill form. With this type of mesothelioma chemotherapy, the drugs circulate throughout your whole body. Systemic chemotherapy treatments can have more side effects, because they also kill non-cancerous cells. This type of chemo has one big advantage: it will find and kill stray cancer cells, wherever they are in your body.

Systemic chemotherapy is administered through injection or by mouth in pill or liquid form. The injected form, called intravenous chemotherapy, is usually administered in a hospital.  You will be hooked up to an IV that delivers the drugs to your body. This mesothelioma chemotherapy treatment may take several hours, while the drugs circulate through your veins and kill cancer cells.

Oral chemotherapy is given through a pill or a liquid medicine. You can take these mesothelioma chemotherapy drugs in your home – no long visits, no needles. These drugs can be just as effective at fighting your cancer as intravenous chemotherapy. Be sure and get clear instructions from your doctor: drugs you take at home are only effective if you remember to take them as instructed. In addition, you may need to use special care when handling and storing oral chemotherapy medication. If you have extra pills left over at the end of your chemotherapy, return them to your doctor’s office or pharmacy for disposal – don’t flush them down the drain.

While they are easier to take, oral chemotherapy drugs can be more expensive than intravenous mesothelioma chemotherapy. You might have to pay more out of pocket for this treatment, if your insurance doesn’t cover the full cost.

Most chemotherapy is administered in cycles. You will receive several treatments over a period of weeks, then have some time off for your body to rest. After a cycle, your doctor may order tests to determine how well the cancer drugs are controlling your mesothelioma.

Regional Mesothelioma Chemotherapy

Regional chemotherapy is administered directly to the part of your body affected by the cancer. This form of mesothelioma chemotherapy may have fewer side effects because it more directly targets the cancer cells. Peritoneal mesothelioma (cancer of the lining around the abdomen) doesn’t respond well to systemic chemotherapy, but regional chemotherapy has been found to be beneficial.

The downside of regional mesothelioma chemotherapy is that it might miss cancer cells that have migrated to other parts of your body.

Hyperthermic intraperitoneal chemotherapy or HIPEC is a regional chemotherapy commonly used for cancers of the abdomen. The drugs are heated before being injected through a tube into your abdomen, where they circulate and attack peritoneal mesothelioma cancer cells. Doctors have found that this combination of heat and chemotherapy drugs can be quite effective for peritoneal mesothelioma.

Intrapleural chemotherapy is a similar treatment for pleural mesothelioma. The chemotherapy drugs are injected into the chest and circulate between the layers of the pleura (the lining around the lungs). Intrapleural chemotherapy treatments may also use heated drugs.

Mesothelioma Chemotherapy Drugs and Drug Combinations

Several different drugs are used for mesothelioma chemotherapy. Your doctor will choose the drug or the drug combination that seems most likely to help you feel better and slow the growth of your tumor. If the first medication isn’t effective or the side effects make you too ill, your doctor will choose a different drug.

The first mesothelioma chemotherapy drug your doctor prescribes is often called the first-line treatment. It is the therapy that is generally considered the most effective. The next chemotherapy drug in line is called the second-line treatment; it may not be as effective, but you may be able to tolerate it better.

One of the most common mesothelioma chemotherapy treatments is a combination of Pemetrexed disodium (usually called Pemetrexed or its brand name, Alimta) and Cisplatin. Both drugs are given intravenously.

Pemetrexed works by blocking some of the enzymes that mesothelioma cells need to reproduce and grow. It is used to treat mesothelioma and non-small cell lung cancer. You should take vitamin B12 and folic acid during chemo to reduce the side effects. Your doctor may also prescribe a steroid to reduce your chance of getting a rash at the injection site.

Cisplatin is derived from platinum. It obstructs DNA and kills fast-growing cancer cells. In time, the cancers of patients treated with Cisplatin may become platinum-resistant and require a different chemo drug.

Carboplatin (brand name Paraplatin) is another intravenous, platinum-based chemotherapy drug. It is also used in combination with Pemetrexed. Carboplatin is gaining in popularity because studies have shown it to work well with fewer side effects than Cisplatin.

Cisplatin and Carboplatin are also sometimes used as a single-drug mesothelioma chemotherapy treatment.

The combination of Pemetrexed and Cisplatin or Carboplatin is considered a first-line mesothelioma chemotherapy treatment because it is effective in slowing down mesothelioma growth in many patients. Some people have a bad reaction to platinum-based drugs, however. If you are one of them, a second-line mesothelioma chemotherapy treatment may work better for you.

Gemcitabine is a second-line mesothelioma chemotherapy treatment. It may be used in combination with Cisplatin or Carboplatin or in combination with other cancer drugs. It is sold under numerous brand names and also as a generic. Gemcitabine is administered by injection. This drug works to kill any cells that are splitting in two. Cancer cells split and grow very quickly, so this drug targets them more than normal cells.

Vinorelbine (sold under the brand name Navelbine) works by obstructing cell division and growth. It is given by injection in the US; an oral version has been approved in Europe.

Doxorubicin interferes with DNA and prevents cells from replicating. This mesothelioma chemotherapy was originally made from a type of bacteria found in the soil in Italy. It is delivered intravenously and may be used alone or in combination with other chemotherapy drugs.

Some other drugs have proved useful as secondary mesothelioma chemotherapy treatments.

  • Onconase is a booster drug for mesothelioma chemotherapy. When taken in conjunction with other chemotherapy drugs, it increases their effectiveness. Onconase blocks cancer cells from their natural tendency to spit out the chemo drugs. When the drugs are pushed out of the cells, doctors have to give higher doses of chemo, which means more side effects. With Onconase, chemotherapy can be more effective at lower doses.
  • Megestrol acetate (MGA) is a synthetic hormone that is used to treat breast cancer and increase appetite in patients with AIDS. For mesothelioma patients, MGA cuts down on the production of hormones that stimulate cancer cell growth. This mesothelioma chemotherapy drug is available in pill form.
  • Lovastatin is usually used to bring down high cholesterol. In mesothelioma patients, it has been shown to impede the growth of mesothelial cells. This may be useful as a secondary therapy.

Mesothelioma Chemotherapy Side Effects

You may be familiar with the most common side effects of mesothelioma chemotherapy: fatigue, nausea, diarrhea, low appetite, hair loss, and chills or fever, among others. In addition, some of the chemotherapy drugs can affect your bone marrow and reduce your production of white blood cells. Without these disease fighters, you are more likely to become ill or get an infection. It’s important to reduce your exposure to germs and keep cuts and incisions clean during and right after chemotherapy.

One of the more severe possible side effects of chemo is reduction in kidney function (because the kidneys can’t deal with the toxicity of the mesothelioma chemotherapy drugs). Other serious side effects can include congestive heart failure, hearing loss, numbness or damaged nerves, and becoming anemic.

Pay attention to your symptoms while you are undergoing mesothelioma chemotherapy and report anything unusual to your doctor. If the treatment is causing too much stress on your body, your doctor will stop the cycle and look for a drug that you can tolerate.

Planning Your Mesothelioma Chemotherapy Visit

There have been great advances in mesothelioma chemotherapy treatment in recent years. Doctors are able to get good effects with lower doses, which means fewer side effects. Still, you should make a plan that takes possible side effects into account.

Before your first chemotherapy treatment, arrange to take some time off work and to have someone help you around the house. Even if all goes well, you will probably be wiped out for several days. It’s a good idea to have someone drive you to and from your first appointment, since you don’t know how you will react to the treatment.

Your doctor may have you do a few other things before your first chemotherapy treatment. If you’re getting the drugs intravenously, you may need to have a catheter or port put in place ahead of time. This allows the hospital to quickly and easily administer the drugs without finding a new vein each time.

Your doctor may also order tests to check on the health of your heart, kidneys, and liver to make sure you are able to withstand possible side effects. Because chemotherapy can decrease your body’s power to fight off germs, you might need to have your dentist check for infections in your mouth. Treating these ahead of time reduces your chance of complications.

Studies suggest that fasting (taking in only water) before and after a chemotherapy treatment can increase the effectiveness of the drugs. During a fast, your normal cells go into a kind of hibernation, but cancer cells keep reproducing. If your chemotherapy kills cells that reproduce quickly, fasting can help the drugs attack only the cancer cells while leaving normal cells unharmed. If you are able to fast for two days before and one day after a treatment, you may find you have fewer side effects and a better outcome.

If you have to spend some time in the hospital while you receive mesothelioma chemotherapy, think about bringing something to distract you. Many cancer patients bring headphones and listen to a book on tape or music. You could watch a movie or read a magazine. Anything that takes your mind off the treatment will make it go faster.