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Understanding Chemotherapy Drugs for Mesothelioma

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Chemotherapy is a cancer treatment with a variety of anti-cancer drugs. It is used frequently to treat mesothelioma. According to Cancer.org, more clinical studies are needed to find the best chemotherapy drugs with a good success rate to fight mesothelioma. Today, the best way to treat asbestos cancer is with chemotherapy combined with surgery. (Cancer.org)

If mesothelioma is treated with surgery, chemotherapy may be used first to attempt to shrink the tumor and reduce the risk of it spreading. This is known as neoadjuvant therapy.

Chemotherapy also can be given to the patient after surgery to kill cancer cells that remain. This is called adjuvant therapy and can help to prevent cancer from coming back.

If surgery does not remove cancer, chemotherapy can be the major treatment option. Chemotherapy could shrink the tumors or slow their growth, but it is uncommon for chemotherapy to make mesothelioma disappear. Below is more information about treatment options for mesothelioma with chemotherapy drugs.

How Chemotherapy Is Given for Mesothelioma

Physicians usually give patients chemotherapy in several cycles. Each treatment period is followed by a rest period that allows your body time to recover. Chemo cycles typically last four weeks. Chemotherapy is seldom recommended for patients in poor health. But being at an advanced age does not mean you cannot receive chemotherapy. (Asbestos.com)

There are two major ways chemotherapy can be given to you to treat mesothelioma:

  • Systemic chemotherapy: Chemo drugs are injected through your vein into the blood. The drug enters the bloodstream and goes through the body to destroy cancer cells.
  • Intrapleural or intraperitoneal chemotherapy: Chemo drugs can be placed into the body where the cancer tumors are. This can be done directly into the chest (intrapleurally), or into the abdomen (intraperitoneally). This type of chemotherapy treatment is done with a small tube or catheter that is put into a small incision in the chest or abdominal wall. Chemotherapy drugs given in this fashion still enter the blood. But the highest levels of drugs go to where the tumors are.

For intrapleural or intraperitoneal chemotherapy, drugs may be heated before they are put into the body. This is known as hyperthermic chemotherapy. Heating the drugs can help them to work more efficiently. This form of chemo may be given as one dose in the OR immediately after the surgery to take out the tumors. This is known as heated intraoperative chemotherapy. It is most frequently used to treat peritoneal cancer; in this case, it is called heated intraperitoneal chemotherapy (HIPEC).

Preparing for Chemotherapy Treatments

Below are the typical steps for getting chemotherapy for mesothelioma:

  • Preliminary testing: You will have heart and blood tests to make sure your body can handle chemotherapy.
  • Port placement: Systemic chemotherapy needs to be delivered through a catheter, port, or pump that is put into a large vein.
  • Dental checkup: You could need a dental visit to check for infections. Proper treatment of any dental infections is necessary to reduce the risks of chemotherapy.
  • Ask for help: If you are experiencing weakness after chemotherapy rounds, ask friends and family for help. Extreme fatigue is common after chemo. You could need their help doing everyday tasks around the home.
  • Prepare for treatment: Drink a lot of liquids, so you are not dehydrated. Eat light meals before your chemotherapy. Also, make sure you get enough sleep and are well-rested. You also will need a ride after your chemo session.

Which Chemotherapy Drugs Are Used for Mesothelioma?

Many chemotherapy drugs can be used on mesothelioma:

  • Pemetrexed
  • Cisplatin
  • Gemcitabine
  • Vinorelbine

These drugs are usually given in combination. But one drug may be used on patients who are too ill to tolerate more than a single drug.

When two chemo drugs are used, most physicians use pemetrexed and cisplatin. Pemetrexed reduces levels of folic acid and vitamin B12 in your body. So patients may receive these to avoid harmful side effects. Other combinations that may be effective on mesothelioma are pemetrexed and carboplatin, or gemcitabine and cisplatin.

Drugs that are used on mesothelioma for HIPEC are:

  • Cisplatin plus doxorubicin
  • Paclitaxel
  • Pemetrexed

Potential Side Effects

Chemotherapy drugs attack cells that divide quickly. That is why they are effective against many cancer cells. But other body cells, such as cells in the bone marrow, the lining of the intestines and mouth, and hair follicles, also divide rapidly. These cells are affected by chemotherapy, which can cause unpleasant side effects. Common side effects of chemotherapy are: (Mesotheliomaguide.com)

  • Hair loss
  • Sores in the mouth
  • Poor appetite
  • Vomit and nausea
  • Diarrhea
  • More chance of infections
  • Easy bleeding and bruising
  • Fatigue from a lower number of red blood cells

Some patients also report what is called ‘chemo brain.’ This involves forgetfulness, foggy thoughts, and other types of cognitive impairment. Many patients have varying levels of impairment that can range from mild to severe. Chemo brain may not last long with some patients. But others can experience chemo brain symptoms for years.

Also, the physical side effects of chemotherapy can cause the mesothelioma patient to struggle with self-esteem problems. This could lead to depression and related emotional issues.

Side Effects Could Diminish After Treatment Is Over

Most of these side effects diminish after treatment ends. But there are ways these side effects can be reduced during chemotherapy. For instance, chemotherapy drugs can be given to reduce or prevent nausea and vomiting. Ask your physician or nurse about drugs that can reduce side effects. Also, let your doctor know if you are experiencing side effects so they can be effectively managed.

Intraperitoneal and intrapleural chemotherapy may cause fewer problems than systemic chemotherapy.

Some chemotherapy drugs may have other side effects. For instance, carboplatin and cisplatin can damage specific nerve cells, also known as peripheral neuropathy. This issue can lead to loss of hearing or loss of sensation in the feet or hands. You also may experience tingling or burning sensations, sensitivity to heat or cold, or general weakness. This problem often will go away over time after the chemotherapy has stopped. But for some patients, the problems can linger for years.

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