Chemotherapy for Malignant Mesothelioma

What Is Malignant Mesothelioma Chemotherapy?

Chemotherapy is a treatment option designed to eliminate cancer cells, particularly those that grow and divide more rapidly than normal, such as diseased mesothelial cells in mesothelioma.

When mesothelioma develops, it spreads by diseased cells replicating at an accelerated rate. Chemotherapy works to destroy these cancer cells and can help to extend a patient’s life.

This treatment involves the use of cytotoxic (anti-cancer) drugs, which are typically administered intravenously through an IV drip. Once in the bloodstream, these drugs target areas of rapid cell growth, disrupting the replication process and causing cancer cells to die.

Chemotherapy is the most accessible treatment for mesothelioma. Patients can receive treatment at a local hospital, a cancer center, an outpatient medical clinic or an infusion center.

Is Mesothelioma Chemotherapy Approved by the FDA?

In 2004, the FDA approved cisplatin and pemetrexed for malignant mesothelioma. There are several studies using pemetrexed in combination with cisplatin that demonstrate a prolonged survival in mesothelioma patients.

Cisplatin, commonly known by its brand name Platinol, is a platinum-based chemotherapy drug. It belongs to the alkylating agent class, which is a group of drugs that interfere with the DNA of cancer cells, preventing them from growing and dividing.

Pemetrexed, sold under the brand name Alimta, is a chemotherapy drug classified as an antifolate antineoplastic agent. This means it works by inhibiting the production of folate, a vitamin essential for DNA and RNA synthesis in rapidly dividing cells. By disrupting this process, pemetrexed prevents cancer cells from growing and multiplying, ultimately leading to their destruction.

In 2020, the FDA approved an injection form of pemetrexed for mesothelioma. The treatment became available in 2022 for patients who are not eligible for surgery.

According to the U.S. National Library of Medicine, the pemetrexed injection is administered for 10 minutes and repeated once every three weeks. This administration requires much less time than standard intravenous chemotherapy (usually lasting at least one hour).

How to Get Chemotherapy Treatment for Mesothelioma

If you have been diagnosed with mesothelioma and are considering chemotherapy treatment, follow these three steps to find the best treatment options:

Types of Chemotherapy for Mesothelioma Treatment

Intravenous chemotherapy, also called systemic chemotherapy, is the main type of mesothelioma chemotherapy. It’s also called systemic chemotherapy. It involves delivering chemotherapy medications through an IV into a vein or port. The drugs travel through the bloodstream to find and kill cancer center.

Other types of mesothelioma chemotherapy are:

• Systemic injection
• Dwell chemotherapy
• Oral chemotherapy
• Spray chemotherapy

Dwell chemotherapy is similar to the HIPEC, where chemotherapy drugs are delivered directly into the chest or abdominal cavity. The ports for dwell treatment are placed in surgery but left in place for extended periods of time. This allows doctors the ability to deliver localized chemotherapy continuously or in cycles for days, weeks or months after surgery.

Oral chemotherapy for mesothelioma is currently under investigation, with one promising drug being Olaparib, marketed under the brand name Lynparza.

A clinical trial at the University of Chicago Medicine is testing the effectiveness and safety of olaparib for mesothelioma patients. Participants receive the drug orally every two weeks, with treatment cycles spanning 28 days. The trial aims to evaluate how well the drug controls tumor growth, its potential to improve survival rates, and the tolerability of side effects.

Spray chemotherapy, or pressurized intraperitoneal aerosol chemotherapy (PIPAC), is another type of chemotherapy being studied in clinical trials.

A study in France used it for peritoneal mesothelioma to see if patients could have cytoreduction/HIPEC surgery afterward. In the study, 13 patients received chemotherapy spray and all of them had surgery after. The average progression-free survival for the patients was 33.7 months.

Multimodal Therapies With Chemotherapy for Mesothelioma

Multimodal therapy is a combination of treatment options used to achieve optimal results. Mesothelioma chemotherapy is often part of a multimodal approach to treating this rare cancer.

Chemotherapy can be used before or after surgery. This multimodal option has presented improved survival rates.

The FDA approved Optune Lua, which is a tumor treating fields device that sends electrical waves, or fields, through the chest to kill cancer cells. This mesothelioma treatment is FDA-approved when paired with systemic chemotherapy.
Other combinations of mesothelioma multimodal therapy pair chemotherapy with:

• Immunotherapy
• Radiation therapy
• Photodynamic therapy

Prepare for Mesothelioma Chemotherapy

Receiving mesothelioma chemotherapy involves planning and preparation. Understanding and planning for potential side effects, the possible need for caregivers, and prioritizing healthy habits can set yourself up for success.

Before going to the hospital for treatment, patients should:

• Make arrangements for help at home, such as a family member or friend assisting with household chores or personal care needs
• Prepare meals well in advance
• Research possible side effects
• Get plenty of sleep the days leading up to treatment

The doctor, nurse or another member of the medical team will provide the information you need to fully prepare you for your mesothelioma chemotherapy treatment. It is important to take notes, ask questions and understand what to expect.

After the mesothelioma chemotherapy treatment, the nurse will explain possible side effects and instruct you to call the doctor with any new or worsening symptoms or side effects. Many of the symptoms and side effects from chemotherapy can be managed, but the medical team must be alerted right away.

Chemotherapy can weaken the body’s immune system. Important things to know are:

• Be cautious in public and around people with colds or infections
• Drink plenty of fluids after chemotherapy, especially water, to maintain hydration, minimize side effects, and flush the body of the toxins from the treatment
• Eat small, frequent meals, and focus on nutritional foods and snacks
• Mobility is important, as walking and light exercises can improve mood and energy levels
• Give yourself time to rest and recover

Talk with your doctor about post-treatment precautions, recommendations, and when to report changes or concerns.

Steps of Mesothelioma Chemotherapy

There are a few steps to receiving mesothelioma chemotherapy. These steps may change depending on the type of chemotherapy:

Intravenous chemotherapy is typically given once every 3 weeks with a rest period in between. The number of cycles may vary for each patient.

Steps of Dwell Chemotherapy for Mesothelioma

Some mesothelioma specialists use dwell chemotherapy, which is different from intravenous chemotherapy. These are the steps for dwell chemotherapy:

NIPEC, or normothermic intraperitoneal chemotherapy, is a form of dwell chemotherapy where the chemotherapy drugs are not heated (like with HIPEC). With this therapy, the patient will return to the medical facility weeks after surgery to have chemotherapy delivered in the chest or abdominal cavity. This length of this procedure may vary depending on the patient and type of chemotherapy ordered by the doctor.

Side Effects of Chemotherapy for Mesothelioma Patients

Like chemotherapy for lung cancer or other types of cancer, chemotherapy for mesothelioma may cause side effects. There are nearly 50 potential side effects of chemotherapy. Some are manageable and mild, while others can be severe and cause serious complications.

Some of the chemotherapy side effects for mesothelioma are:

• Nausea and vomiting
• Body aches
• Fatigue
• Changes to taste
• Mouth sores
• Loss of weight and appetite

Chemotherapy drugs may also lead to more severe side effects:

• Itching and rashes
• Bleeding
• Increased risk of infection
• Damage to the liver or heart
• Inflammation of digestive tract membrane linings

Eating smaller portions more often, taking regular naps, avoiding fatty foods, and regular light exercise are just a few ways to minimize these side effects.

Antiemetic drugs, which are drugs that reduce nausea and vomiting, are often prescribed for patients receiving chemotherapy. Doctors may recommend patients take these medications as a preventative measure to avoid nausea and vomiting, which can lead to more serious complications like weight loss, weakness and malnutrition.

Chemo Brain from Mesothelioma Chemotherapy

“Chemo brain” refers to cognitive changes that some people experience during or after chemotherapy treatment. It often involves difficulties with memory, concentration, multitasking, and processing information.

While the exact cause isn’t fully understood, it’s thought to result from a combination of chemotherapy effects, fatigue, stress, and other factors. Symptoms can vary in severity and duration, with most improving over time. Strategies like mental exercises, organization tools, and lifestyle adjustments can help manage the condition.

The effects of chemo brain include:

• Decreased short-term memory
• Trouble finding words
• Decreased attention span
• Difficulty concentration
• Problems multitasking

Symptoms of chemo brain often improve within 9-12 months. However, there is a chance that individuals may have long-term effects. Some of the ways to prevent or overcome chemo brain include:

• Mental challenges and games (crossword puzzles or Wordle, for instance)
• Memory exercises (repeating words or ideas to help remember them)
• Taking notes, journaling, or making lists

Chemotherapy Drugs Used for Mesothelioma

The top chemotherapy drugs for mesothelioma are cisplatin and pemetrexed. They are the only two approved by the FDA for this cancer.

Other mesothelioma chemotherapy medications used in clinical trials or as substitutes are:

• Carboplatin
• Gemcitabine
• Vinorelbine

Carboplatin is often a substitute when patients have a reaction to cisplatin. It can help some patients with side effects. Gemcitabine and vinorelbine are still under investigation and testing. These chemotherapy drugs are used for pleural mesothelioma.

For peritoneal mesothelioma, the combination of cisplatin and pemetrexed is used as a systemic chemotherapy treatment. When surgery is a treatment option, doctors may opt for the chemotherapy drugs doxorubicin and mitomycin during cytoreductive surgery with heated intraperitoneal chemotherapy. For this doctors may use the chemotherapy drugs doxorubicin and mitomycin.

Mesothelioma Chemotherapy Survival Rates

The average survival for patients treated with standard (systemic) mesothelioma chemotherapy on its own is 12-17 months. The variance depends on factors such as patient selection and the type of mesothelioma.

Doctors have begun administering a combination of drugs to achieve improved survival rates for mesothelioma. The most common pairing is pemetrexed and cisplatin. A study published in the Journal of Thoracic Disease reported a median survival of 12 months for systemic cisplatin and pemetrexed. Patients receiving cisplatin without pemetrexed had a median survival of 9 months.

Peritoneal mesothelioma has a slightly better survival rate with systemic chemotherapy. One study reported a median survival of 17 months for patients who received only this treatment.

Mesothelioma survival rates usually increase for intraoperative chemotherapy, or when systemic chemotherapy is part of multimodal treatment. These statistics were compiled from various studies:

• 16 months median survival for systemic chemotherapy before or after pleural mesothelioma surgery
• 22 months median survival for heated intraoperative chemotherapy plus pleurectomy with decortication for pleural mesothelioma
• 35 months median survival for surgery, photodynamic therapy and systemic chemotherapy for pleural mesothelioma
• 53 months median survival and 47% five-year survival rate for HIPEC with cytoreductive surgery for peritoneal mesothelioma