Mesothelioma Chemotherapy Medications

Top Chemotherapy Drugs for Mesothelioma

There are five chemotherapy drugs used most often in mesothelioma treatment. They are:

Only pemetrexed and cisplatin are approved by the FDA for malignant mesothelioma. Carboplatin is approved as a substitute for cisplatin.

Pemetrexed

Pemetrexed is the generic name for Alimta. It was approved by the FDA in 2004. Pemetrexed is an antifolate antineoplastic agent. This means it fights cancer cells by disrupting the production of folate, which is necessary for cell growth and division.

Doctors usually give pemetrexed intravenously. Other methods are intraoperatively, usually as a heated liquid delivered into the chest or abdomen.

Pemetrexed’s antifolate characteristics affect healthy cells, which can cause nausea and low blood cell counts. Doctors often prescribe patients with a vitamin B12 supplement or folic acid to protect healthy cell count.

Cisplatin

Cisplatin, the generic name for Platinol, was FDA approved in 2004 with pemetrexed. It’s an alkylating agent, meaning it attacks cancer cells during their resting phase.

The drug is usually administered intravenously through an infusion. The other method is intraoperatively as a hot liquid substance.

Cisplatin can cause diarrhea, nausea, vomiting and low blood cell count.

Carboplatin

Carboplatin is FDA approved for malignant mesothelioma as a substitute for cisplatin. It can prevent some or all of the side effects of cisplatin. It’s also less taxing on the kidneys.

Similar to cisplatin, carboplatin is an alkylating agent. It attacks cancer cells while they are resting, damaging their genetics and disrupting their division.

Carboplatin is given intravenously or intraoperatively.

Gemcitabine

Gemcitabine, the generic name for Gemzar, is an experimental chemotherapy drug for malignant mesothelioma. It’s also used for non-small cell lung cancers along with cancers of the breast, bladder and pancreas.

Gemcitabine is an antimetabolite, meaning it disrupts the cells’ metabolism and prevents division. It’s administered intravenously.

Vinorelbine

Vinorelbine, the generic name for Navelbine, is an experimental chemotherapy medication for malignant mesothelioma. It is also used for non-small cell lung cancers.

Vinorelbine is a vinca alkaloid, which interferes with the microtubule structures within cancer cells. The drug prevents division and replication.

The drug is given intravenously. Aside from usual side effects, vinorelbine can cause burning or swelling at the infusion site.

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Chemotherapy Drug Combinations for Mesothelioma

The main combination for mesothelioma is pemetrexed and cisplatin. Another pairing is pemetrexed and carboplatin. Survival improves when patients receive multiple mesothelioma medications versus just one.

Cisplatin and Pemetrexed for Mesothelioma

Multiple studies report cisplatin and pemetrexed for mesothelioma has a median survival of one year. A 2008 study of hundreds of mesothelioma patients concluded a four-month increase in survival for this combination compared to patients only taking cisplatin.

The recommended dose of pemetrexed is 500 mg/m for 10 minutes administered every 21 days. The recommended dose of cisplatin is 75 mg/m for two hours on the same day as the pemetrexed dosage.

Carboplatin and Pemetrexed

The combination of carboplatin and pemetrexed has a survival of 12-14 months. One study reported 12.7 months and another reported 14 months.

Bevacizumab, Pemetrexed and Cisplatin

Bevacizumab, the generic name for Avastin, is an experimental drug for mesothelioma. It’s an anti-angiogenic drug, meaning it disrupts the creation of new blood vessels (angiogenesis). Bevacizumab accomplishes this by targeting a growth protein in cancer cells.

It can be combined with the pemetrexed-cisplatin pairing. According to a 2016 study, the median survival time was 18.8 months.

The drug is administered intravenously.

Vinorelbine and Cisplatin

Vinorelbine is an experimental substitute for pemetrexed. A 2008 study of vinorelbine and cisplatin had a one-year survival rate of 61% and a two-year rate of 31%.

Pemetrexed and Gemcitabine

Gemcitabine is an experimental substitute for cisplatin. A 2015 study of non-small cell lung cancer patients found a median survival time of 15 months.

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Frequently Asked Questions About Mesothelioma Chemotherapy Medications

What are the best chemotherapy drugs for mesothelioma?

Pemetrexed and cisplatin are the top chemotherapy drugs for malignant mesothelioma. They are best as a combination, with patients often surviving 12-14 months.

Which chemotherapy drugs are FDA approved?

The FDA approved cisplatin and pemetrexed for mesothelioma in 2004. Carboplatin is approved as a substitute for cisplatin. Alimta is the brand name for pemetrexed.

What other chemotherapy drugs work for mesothelioma?

Vinorelbine and gemcitabine are experimental chemotherapy medications for mesothelioma. Bevacizumab is an anti-angiogenic drug that prevents the growth of blood vessels. It works as a third drug with pemetrexed and cisplatin. The trio led to median survival of 18 months in mesothelioma cases.

Sources & Author

1. FDA drug approval summaries: pemetrexed (Alimta). Oncologist. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/15477632/. Accessed: 04/28/2021.
2. Phase II Study of Pemetrexed Plus Carboplatin in Malignant Pleural Mesothelioma. Journal of Clinical Oncology. Retrieved from: https://ascopubs.org/doi/10.1200/JCO.2005.04.3190. Accessed: 04/28/2021.
3. Review of pemetrexed in combination with cisplatin for the treatment of malignant pleural mesothelioma. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503655/. Accessed: 05/16/19.
4. Cisplatin and vinorelbine first-line chemotherapy in non-resectable malignant pleural mesothelioma. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453034/. Accessed: 05/16/19.
5. Pemetrexed and gemcitabine versus carboplatin and gemcitabine in non-small cell lung cancer: a randomized noninferiority phase II study in one center. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25732264. Accessed: 05/16/19.
6. Comparison of cisplatin plus pemetrexed and cisplatin plus gemcitabine for the treatment of malignant pleural mesothelioma in Japanese patients. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/24636265. Accessed: 05/16/19.
7. Alimta Approval History. Drugs.com. Retrieved from: https://www.drugs.com/history/alimta.html. Accessed: 05/16/19.
8. Alimta. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/alimta.aspx. Accessed: 05/16/19.
9. Cisplatin. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/cisplatin.aspx. Accessed: 05/16/19.
10. Carboplatin. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/carboplatin.aspx. Accessed: 05/16/19.
11. Gemcitabine. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/gemcitabine.aspx. Accessed: 05/16/19.
12. Vinorelbine. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/vinorelbine.aspx. Accessed: 05/16/19.
13. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26719230?dopt=Abstract. Accessed: 05/16/19.
14. Avastin. Chemocare. Retrieved from: http://chemocare.com/chemotherapy/drug-info/avastin.aspx. Accessed: 05/16/19.

About the Writer, Devin Golden

Devin Golden is the senior content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.