Chemotherapy

Chemotherapy is a common treatment for mesothelioma, as it is for many types of cancer. Chemotherapy agents act by attacking and killing cancer cells, thereby preventing them from dividing rapidly. No standard protocol for administering chemotherapy exists: Treatments may vary in number, the way the drugs are administered (orally or intravenously), and the drug or combination of drugs. While certain chemotherapy drugs are often associated with mesothelioma treatment (in particular Alimta, Cisplatin, Carboplatin And Gemcitabine), new and promising drugs continue to be researched and tested.

Chemotherapy can be used before or after surgery, or in cases where surgery is not an option. Neoadjuvant chemotherapy (before surgery) can reduce tumor size and make it easier to remove the cancer. Adjuvant chemotherapy (after surgery) will help lessen the chances of cancer spreading or returning. Palliative chemotherapy is often given in conjunction with other treatments and can alleviate symptoms as well as increase life expectancy.

Chemotherapy agents cannot always reliably distinguish between cancer cells and healthy ones, and as a result each drug has attendant side effects that may include hair loss, fatigue, nausea/vomiting, digestive problems and loss of appetite. While the side effects generally disappear once chemotherapy has stopped, it is important to consult your doctor about possible side effects and how to deal with them.

While certain chemotherapy drugs are often associated with mesothelioma treatment, new and promising drugs continue to be researched and tested.
 

Combination therapy

Though some chemotherapy agents are used as stand-alone treatments, clinical trials have shown that using two or more in combination often works better than a single agent. Many doctors are therefore now using two or more chemotherapy drugs simultaneously. Furthermore, new combinations and regimens are constantly being developed and tested. In addition, chemotherapy is often used in combination with surgery and radiation therapy to treat all types of mesothelioma. Studies have shown that combination therapy, while not providing a cure, does consistently extend survival rates.

In recent decades, more people are employing alternative treatments in conjunction with conventional methods, though the effectiveness of these treatments has not been the subject of much scientific research and remains anecdotal in nature.

Because the science of chemotherapy treatment for mesothelioma is constantly evolving, you want to find an experienced specialist who is well-versed in the many treatment options and combinations that may be available. If you aren’t sure how to find the best doctor, the Mesothelioma Options Help Center can put you in touch with skilled and knowledgeable providers.


Drugs Commonly Used with Chemotherapy

Alimta

The most common chemotherapy drug used to treat mesothelioma (and the first to be approved by the Food and Drug Administration), Alimta is the brand name for the drug Pemetrexid. Chemotherapy can be used before or after surgery, or in cases where surgery is not an option, as a palliative measure to relieve symptoms.

Alimta is in a class of medications called antifolate antineoplastic agents which work by inhibiting enzymes that the cancer cells use to proliferate, thereby blocking the ability of the cancer to spread. Primarily used to treat pleural mesothelioma, Alimta is given by injection and is usually administered once every 21 days.

Like most chemotherapy drugs, Alimta is usually used in combination with other chemo agents, especially Cisplatin. Studies have shown that combinations of chemo drugs tend to work better than individual drugs alone; in one clinical trial, for example, patients treated with Alimta in combination with cisplatin were shown to survive about three months longer than the patients who received only Cisplatin.

Before Alimta is prescribed, your doctor will ask about your medical history, any allergies to prescription drugs you may have and other information that will be useful. Blood tests will also be taken before and during treatment to ensure that you’re getting the optimal dosage.

As with any chemotherapy drug, Alimta can have multiple side effects, although it is often hard to pinpoint whether the drug or the cancer itself causes them. The most common side effects of Alimta include stomach upset, nausea, vomiting, diarrhea, a drop in white blood cell count (which increases the risk of infection), anemia, fatigue, dizziness, shortness of breath, mouth, throat, or lip sores, loss of appetite, and rash. Alimta can also be associated with mood changes and depression. To limit or alleviate these side effects, your doctor may prescribe a vitamin regimen or a corticosteroid.

Cisplatin

Cisplatin is a chemotherapy agent most often used to treat testicular, bladder, ovarian, lung, stomach cancers as well as mesothelioma. The first drug developed in the group of medicines known as platinum containing compounds or alkylating agents, Cisplatin is administered intravenously and is often given in combination with other chemotherapy agents, especially Alimta (pemetrexid).

Cisplatin works by interfering with the growth of cancer cells, either slowing their growth or destroying them. As with all chemotherapy treatments, Cisplatin can also inhibit or damage normal cells, which can cause side effects. These can range from mild to serious, so doctors will closely monitor each patient’s response to the drug. Side effects can include kidney damage, nausea, vomiting, trouble hearing, fatigue, and a reduction in the production of red and white blood cells that can in turn increase the risk of infection and internal bleeding.

To reduce the chance of damage to the kidneys, it is very important for patients to drink plenty of fluids and keep well hydrated. Most doctors recommend 8 to 12 glasses of liquid on the day the medicine is taken and for two days thereafter. Other IV medication is often given to keep patients from dehydrating. Additionally, patients will likely be given vitamin, mineral and other supplements to reduce the risk of depletion during treatment. 

Before starting Cisplatin treatment, patients should discuss its effects on fertility and their ability to conceive after treatment. Because side effects can be serious, your doctor will take a complete history to determine if the drug is appropriate and to prescribe the correct dosage and frequency.


Taxotere

Taxotere is a chemotherapy agent popularly used to treat cancer that is discovered or recurs after previous chemotherapy that is medically know as Docetaxel. It is part of a group of medicines called taxanes, which derive from the bark or pin needles of certain types of yew trees. Taxotere differs significantly from Alimta and Cisplatin in the way it fights mesothelioma.

Unlike most chemotherapies, Taxotere does not stop cancer by attacking the DNA or RNA of cancer cells. Instead, it interferes with the cell's microtubules, structures that help the movement of other key cell components during mitosis (division). By attacking the microtubules, Taxotere stops cancer cells from successfully dividing. In multiple clinical trials, Taxotere demonstrated a high tumor response rate compared to other chemotherapy agents as a second-line treatment for recurring cancers.

Taxotere is administered intravenously for a variety of cancers, usually every 21 days. It is mostly used if a cancer returns after such platinum based chemotherapy as Cisplatin.

While all chemotherapy drugs can be toxic and have serious side effects, another benefit of Taxotere is that side effects have been demonstrated to be less severe than with other chemo agents. Possible side effects of Taxotere include nausea, vomiting, fatigue, a reduction in production of blood cells and a consequent increased risk of infection and internal bleeding, skin rash, fluid retention, hypersensitivity, hair loss and diarrhea.

Before starting Taxotere treatment, patients should discuss its effects on fertility and their ability to conceive after treatment. Also, vaccinations should not be taken during treatment, as they can cause patients to be immuno-compromised.


Gemzar

Gemcitabine, one of the newer chemotherapy agents that have come on-line in recent years, is most commonly used to treat cancers of the lung and pancreas as well as mesothelioma. Gemcitabine prevents cancer cells from making DNA and RNA by interfering with the synthesis of nucleic acids, which stops or slows cell growth.

Marketed under the brand name Gemzar among others, Gemcitabine belongs to a group of medicines called antimetabolites. Most often used in combination with one or more other chemotherapy agents such as Cisplatin, it is given intravenously. Recent studies also show promising results from combining Gemcitabine with inhibitors of vascular endothelial growth factor (VEGF), increased levels of which are associated with mesothelioma.

Gemcitabine is only one of many newer chemotherapy agents that are being used to treat mesothelioma, and chemotherapy is only one of several mesothelioma treatments that your doctor may choose depending on the patient’s individual circumstances. Figuring out which options are best can be both confusing and stressful for the patient. 

Because Gemcitabine sometimes also affects normal cells, it can cause side effects. These may include nausea, vomiting, damage to kidneys, fatigue, reduced production of red and white blood cells with a consequent increase in the risk of infections and internal bleeding, loss of appetite, changes in liver and kidney function, swelling, rashes, flu-like illness, diarrhea and hair thinning.

Kidney and liver changes are usually undetected by the patient but are closely watched by doctors during treatment. Medications are prescribed if rashes and diarrhea develop, and hair will grow back once the treatment is over.

Before starting Gemcitabine treatment, patients should discuss its effects on fertility and their ability to conceive after treatment; the drug may cause birth defects, so women should be careful to avoid getting pregnant when taking the medication. Also, vaccinations should not be taken during treatment, as they can compromise patients’ immune systems.