Chemotherapy for Malignant Mesothelioma

Chemotherapy is the use of drugs for treating cancer. The drugs can be swallowed in pill form or they can be injected by needle into a vein or muscle. Chemotherapy is systemic therapy. This means that the drug enters the bloodstream and circulates throughout the body (through the whole system) to reach and destroy the cancer cells.

To treat mesothelioma, these drugs may also be given intrapleurally (directly into the chest cavity) or intraperitoneally (into the abdominal cavity). Based on the type and stage of mesothelioma, chemotherapy may be given as the primary (main) treatment or as an adjuvant treatment (treatment given in addition to the primary treatment) to surgery. Chemotherapy for this disease is palliative and not curative.

Several chemotherapy drugs have been used to treat mesothelioma. The preferred combination of drugs for now is pemetrexed (Alimta), which is combined with cisplatin. Because pemetrexed interferes with normal metabolism of folic acid and vitamin B12, these must also be given to avoid side effects. Another combination that has a good response rate is cisplatin and gemcitabine. Another option substitutes cisplatin with carboplatin, which causes much less nausea and vomiting.

Other combinations of drugs used to treat mesothelioma include:

methotrexate and vincristine
cisplatin, vinblastine and mitomycin
cisplatin and doxorubicin
doxorubicin, cyclophosphamide (or ifosfamide), and cisplatin
All the drugs above can be given alone in people who may not be able to tolerate two drugs. Other drugs such as paclitaxel and irinotecan are being studied to determine their effectiveness in treating mesothelioma.

A new, related drug called raltitrexed has also been shown to help patients with mesothelioma when given with cisplatin. Patients who received these drugs lived longer than those who received cisplatin alone.

Chemotherapy drugs kill cancer cells but also damage some normal cells. Therefore, your doctor will pay careful attention to avoiding or minimizing side effects, which depend on the specific drugs, the amount taken, and the length of treatment. Temporary side effects might include nausea and vomiting, loss of appetite, loss of hair, and mouth sores.

Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in an increased risk of infection (due to a shortage of white blood cells); bleeding or bruising after minor cuts or injuries (due to a shortage of blood; platelets); or fatigue or shortness of breath (due to low red blood cell counts).

Most side effects disappear once treatment is stopped. There are remedies for many of the temporary side effects of chemotherapy. For example, you can be given drugs to prevent or reduce nausea and vomiting. If you experience any side effects, be sure to talk with your doctor.

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