We know that mesothelioma patients would rather stay local when receiving treatment,rnso we will review options for private medical centers, surgical consultants, clinical trials,rnand match you up with friendly, local physicians wherever we can.

1. Home / Treatment Options / Chemotherapy
Mesothelioma Chemotherapy
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2. Chemotherapy is the use of drugs to treat cancer. Along with radiation therapy and surgery, chemotherapy is one of the
conventional treatment options for malignant mesothelioma. Not all patients are healthy enough for chemotherapy. The decision to
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undergo chemotherapy—as well as other considerations such as which chemo drugs are right for you, how the drugs are
delivered, the duration of treatment, and whether chemo will be used alone or with other therapies—will be made with guidance
from a medical oncologist and based on your functional status.
How Chemotherapy Works
Cell division is a normal part of normal tissue function. Normal cells divide and proliferate according to a
genetically controlled process. Cancer cells, on the other hand, are the result of mutations and do not
behave as normal cells do. They divide rapidly and uncontrollably and group together to form tumors.
Chemo drugs target rapidly-dividing cells. This includes not only cancer cells but also healthy cells, which is why chemotherapy
produces side effects.
But cancer cells divide with much greater frequency than most normal cells and are more likely to be affected by Chemotherapy.
Although different chemotherapies work in somewhat different ways, the drugs’ general mechanism of action involves damaging
the genes of cancer cells, thus stopping them from dividing uncontrollably and shrinking tumors. Ideally, chemotherapy kills all
cancer cells, but in the case of mesothelioma, it more often helps to temporarily control tumor growth.
A newer class of chemotherapies known as targeted therapies hone in on specific molecules within cancer cells, rather than acting
against all dividing cells. While targeted chemo drugs affect the body differently than standard chemo drugs, they can still produce
side effects. Targeted therapies for mesothelioma are still in the developmental stages, but interested patients may be able to
undergo treatment with them in a clinical trial.
Undergoing Chemotherapy
The information presented below is intended to inform you about chemotherapy for malignant mesothelioma. It is not a substitute
for professional medical advice. We can, however, put you in touch with the country’s top mesothelioma specialists.
Multimodal Therapy
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4. Chemotherapy on its own is unlikely to completely eradicate mesothelioma, but chemo can slow the progression of mesothelioma,
alleviate symptoms, and improve quality of life. This type of chemotherapy is known as palliative chemotherapy.
Combined with surgery (either before or after a pleurectomy/decortication or extrapleural pneumonectomy) chemotherapy
is potentially curative. In fact, some patients have been declared cancer free after surgery and chemotherapy, although this
outcome is rare.
The use of two or more of chemotherapy, radiation therapy, and surgery is called multimodal therapy. Specialists may
recommended the use of all three treatments, or trimodal therapy.
Neoadjuvant and Adjuvant Chemotherapy
Neoadjuvant chemotherapy is chemotherapy given before surgery. Pre-surgical chemo can shrink mesothelioma tumors, treat
cancer that has spread to the lymph nodes, and may permit less invasive surgery. Adjuvant chemotherapy is chemotherapy given
after surgery. The goal of post-surgical chemo is to destroy cancer cells that the surgeon may have missed and prevent the cancer
from coming back.
What Are the Different Types of Drugs Used?
Although chemotherapy drugs for mesothelioma all work in different ways, their general purpose is to damage or kill the cancer
cells, in turn preventing them from dividing uncontrollably. In some forms of cancer, the chemotherapy drugs completely kill all the
cells, but for mesothelioma patients, chemotherapy is often most effective at controlling the growth of tumors.
That National Cancer Institute outlines four common classes of chemotherapy drugs:
Alkylating agents: These types of drugs act directly on DNA to prevent cells from dividing. Alkylating agents, which can kill cells
whether they are in the process of dividing or in a resting state, are generally most effective in treating slow-growing cancers.
Antimetabolites: Antimetabolites mimic the nutrients that cells need to grow, thereby tricking the cancer cells into consuming
them and eventually causing the cells to starve to death due to lack of nutrients. Antimetabolites primarily act on cells that are
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5. undergoing synthesis of new DNA for the formation of new cells.
Plant alkaloids: These antitumor agents, which are derived from plants, also work by blocking the cancer cells from dividing and
becoming two cells. These drugs are most effective when the cancer cells are in the process of separating and synthesizing their
DNA.
Antitumor antibiotic: These types of drugs cause the strands of genetic material that make up DNA to uncoil, thereby preventing
the cancer cell from reproducing. It is important to note that these are not the same types of drugs that are used as antibiotics
common in treating bacterial infections.
In addition to the standard types of chemotherapy drugs, targeted immunotherapy for mesothelioma is emerging as another
alternative treatment. This type of treatment aims to use the body’s own immune system to fight off the cancer cells.
What Are the Common Chemotherapy Drugs for Mesothelioma?
So far, the Food and Drug Administration has only approved the chemotherapy drugs pemetrexed and a combination of
gemcitabine and cisplatin for treatment of mesothelioma. However, even though a chemotherapy drug or a specific drug
combination has not yet been approved by the FDA as a mesothelioma treatment, your doctor may still consider it an option for
you.
There are actually several chemotherapy drugs that can be used to treat mesothelioma, according to the American Cancer
Society. These include:
Pemetrexed (Alimta)
Cisplatin (Platinol, Platinol-AQ)
Carboplatin (Paraplatin)
Gemcitabine (Gemzar)
Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
Vinorelbine (Navelbine)
Mitomycin (Mutamycin)
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6. Doxorubicin (Adriamycin, Rubex)
Your doctor may opt to use one or a combination of chemotherapy drugs in the first set of treatment cycles, also known as first-line
therapy. If that first-line therapy does not have the intended effect, a second-line therapy may be recommended. In this second
round of chemo, your doctor may consider using a different drug or drug combination.
Cycles
Pemetrexed and cisplatin chemotherapy is typically administered in 4-6 cycles, with a recovery period of
three weeks between cycles. The drugs are delivered intravenously through a short thin tube in your arm or
hand (a cannula), a fine tube under the skin of your chest (a port, or portacath), or a fine tube put into a
vein in your arm that connects to a vein in your chest (PICC line). Initial chemotherapy cycles are
called first-line therapy.
If mesothelioma recurs or progresses following first-line chemotherapy, second-line therapy, or additional
cycles of chemotherapy drugs, might be recommended. The same drug regimen that was used for first-line therapy may be used
for second-line therapy, or a new regimen may be introduced. When cancer drugs are delivered intravenously, they travel
throughout the body and attack cancer cells in many locations. This is known as systemic chemotherapy.
Intrapleural and Intraperitoneal
Not all chemotherapy is systemic. In some cases, heated drugs are delivered directly to the site of the
cancer after cancerous cells have been removed, but while the patient is still in surgery. This warm bath of
chemo drugs sends a more intense dose of chemotherapy directly to where its needed.
Intrapleural chemotherapy is the use of heated chemo drugs following a pleurectomy or extrapleural
pneumonectomy (EPP). Heated intraperitoneal chemotherapy (HIPEC) is given to peritoneal
mesothelioma patients after all visible abdominal tumors are removed. Research has shown that cancer
cells respond better to higher temperatures. The drugs most often used for hyperthermic chemotherapy are mitomycin or a
combination of doxorubicin and cisplatin.
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7. What Drug Combinations Are Used for Mesothelioma?
Chemotherapy drug combinations are commonly used to help boost the effectiveness of mesothelioma treatment. These
combinations generally include two chemotherapy drugs that may act on cancer cells in different phases of the cells’ development.
The most common drug combinations used to treat mesothelioma is pemetrexed and cisplatin.
However, other combinations include:
Pemetrexed and carboplatin
Pemetrexed and gemcitabine
Carboplatin and gemcitabine
Cisplatin and gemcitabine
Cisplatin and doxorubicin
Cisplatin and mitomycin
Cisplatin and vinorelbine
It’s important that patients talk to their doctors about all their treatment options, including what chemotherapy drug combinations
for mesothelioma are being studied as part of clinical trials. The landscape for mesothelioma treatment options is constantly
changing, and chemotherapy is a field that could see great strides and give hope to many patients in the future.
Side Effects
The side effects of chemotherapy can be hard on a mesothelioma patient, especially considering that most people are diagnosed
with the cancer at an older age. Your doctor will take into account your age and general health in determining which chemotherapy
drugs or drug combinations may work best for you and what side effects you may or may not be able to tolerate.
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8. It is also important to note that everyone reacts differently to chemo, so you may not experience all (or any) of the side effects
listed.
Chemotherapy
Drug
Brand Name(s) How It’s Given Most Common Side Effects
Pemetrexed Alimta Injection/IV
Low white blood cell count
Low red blood cell count
Fatigue
Nausea and vomiting
Constipation
Poor appetite
Shortness of breath
Chest pain
Cisplatin Platinol, Platinol-AQ IV or infusion into the abdominal
cavity (intraperitoneal)
Nausea and vomiting
Kidney toxicity
Blood test abnormalities (low magnesium, low
calcium, low potassium)
Low white blood cell count
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9. Low red blood cell count
Carboplatin Paraplatin
IV or infusion into the abdominal
cavity
Low blood counts (including red blood cells,
white blood cells and platelets)
Nausea and vomiting
Taste changes
Hair loss
Weakness
Blood test abnormalities (magnesium levels)
Gemcitabine Gemzar IV
Flu-like symptoms
Fever
Fatigue
Nausea (mild)
Vomiting
Poor appetite
Skin rash
Low blood counts
Temporary increases in liver enzymes
Blood or protein in the urine
Methotrexate
Otrexup, Rasuvo,
Rheumatrex, Trexall
IV, injection into the muscle (IM), pill
Low blood counts
Mouth sores
Poor appetite
Vinorelbine Navelbine IV
Low blood counts
Nausea or vomiting
Muscle weakness
Constipation
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10. Mitomycin Mutamycin IV Low blood counts
Mouth sores
Poor appetite
Fatigue
Doxorubicin Adriamycin, Rubex IV
Pain along the site where the medication was
given
Nausea or vomiting
Low blood counts
Hair loss
In addition to these more common side effects, some patients may experience other reactions to chemotherapy drugs. It is
important that you talk to your doctor about what to expect from the chemo treatment you are undergoing. And always tell your
medical team about the side effects you are experiencing so they can adjust your chemotherapy regimen if needed.
How Long Do Chemotherapy Drugs Stay in Your System?
The drugs themselves do not stay in your system for very long. However, the side effects can take time to dissipate. The amount
of time it takes for side effects to subside really varies from person to person. If you are concerned about how long your
chemotherapy side effects have been lingering, discuss your concerns with your doctor.
Keep in mind that although the effects of chemotherapy can be difficult to cope with in the short term, the goal of the treatment is to
fight the mesothelioma, prolong your life, and make you feel better in the long run. And remember, you are not along in this fight.
There is a community of mesothelioma survivors, caregivers and medical professionals here to lean on.
Deciding What Type of Chemo Is Right for You
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11. If you or a loved one has been diagnosed with mesothelioma, it is important that you seek treatment advice from a medical
professional who specializes in this specific type of cancer. In addition to understanding what chemotherapy drugs for
mesothelioma are traditionally given, a specialist will also be able to discuss you options for pursuing clinical trials and alternative
treatment methods.
If you need help finding a doctor or have any questions related to mesothelioma treatment options, contact us today. We are here
to give patients the information they need, the help they deserve, and the hope that will sustain them through this difficult process.
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13. We’d like to offer you our in-depth guide, “A Patient’s Guide to Mesothelioma,” absolutely free of charge.
It contains a wealth of information and resources to help you better understand the condition, choose (and afford) appropriate
treatment, and exercise your legal right to compensation.
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