Mesothelioma chemotherapy is a standard treatment using powerful anti-cancer drugs to destroy cancer cells. These drugs can shrink tumors, slow or stop progression, reduce cancer symptoms and improve quality of life. The most common chemotherapy drug combination is Alimta and cisplatin.
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Chemotherapy drugs surround and enter mesothelioma cells to kill them or stop them from spreading. These powerful drugs target fast-growing cells like those in mesothelioma tumors.
As Dr. J. Marie Suga, an oncologist at Kaiser Permanente, explained to The Mesothelioma Center, “In general, chemotherapy drugs disrupt the division of cells that divide quickly. This prevents cancer cells from replicating and growing.”
Chemotherapy penetrates cancer cells and limits spreading to other tissues and organs.
Chemotherapy is used as a first-line treatment to kill mesothelioma cancer cells. However, the drugs can also harm healthy cells. The exact drugs received depend on the nature of your mesothelioma diagnosis.
Chemotherapy is sometimes used along with other targeted therapies in a multimodal treatment program for mesothelioma. In some cases, chemotherapy is used palliatively to reduce the mesothelioma symptoms pressure from tumors can cause.
Key Facts About Chemotherapy for Mesothelioma
The standard treatment for malignant pleural mesothelioma is a combination of Alimta (pemetrexed) and Platinol (cisplatin). Patients who can’t tolerate cisplatin may receive carboplatin.
Following cytoreductive surgery to surgically remove tumor cells with circulating hyperthermic intraperitoneal chemotherapy in the abdomen is the most common surgical treatment for peritoneal mesothelioma.
Doctors may use chemotherapy alone or in combination with surgery depending on a patient’s suitability for each treatment.
How Is Mesothelioma Chemotherapy Administered?
Chemotherapy is commonly administered through an IV line. Doctors can also pump it directly into the chest or abdomen during surgery to remove mesothelioma tumors. Known as hyperthermic intrathoracic chemotherapy, this allows for targeted drug placement that limits damage to surrounding tissues.
Patients typically receive chemo in 3- to 4-week cycles. A cycle begins with an active treatment period, followed by a rest period for the body to recover from the powerful chemotherapy drugs. Alimta prescribing information calls for one dose on day 1 of each 21-day treatment cycle with or without cisplatin. Follow-up visits typically begin a few weeks after your treatment cycle, especially if you have a maintenance chemotherapy plan.
Types of Chemotherapy Administration
Oral or IV Chemotherapy: Known as systemic chemotherapy, doctors or nurses administer the drugs orally or through an IV line in a vein or a port. The drugs travel throughout the bloodstream. Patience may receive this treatment alone or with other therapies for mesothelioma.
In-Surgery Chemotherapy: Surgeons deliver intraoperative chemotherapy during surgery when the cancer site is open and exposed, known as intracavitary chemotherapy. After warming the chemicals, an infusion pump disperses the chemo through the abdominal or chest cavity. A drain helps to remove the fluid after treatment.
Intracavitary chemotherapy, including HIPEC and NIPEC, allows direct contact between the chemo drugs and affected tissue. This reduces the impact on healthy tissue and lowers the risk of side effects. According to results from a 2023 study in the Turkish Journal of Thoracic and Cardiovascular Surgery, “hyperthermic intrathoracic chemotherapy following cytoreductive surgery is a preferable and tolerable method in the treatment of malignant pleural mesothelioma.”
Other emerging therapies offer promising results for patients with mesothelioma. Preliminary data from a trial published in the International Journal of Surgery Protocols indicated following cytoreductive surgery and HIPEC with long-term IV cisplatin and intraperitoneal Alimta resulted in a 5-year survival rate of 75% for patients with malignant peritoneal mesothelioma.
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Alimta is the standard chemotherapy drug used to treat mesothelioma. Doctors often administer Alimta along with cisplatin through an IV line or port. Treatment occurs over 1 day every 3 weeks.
Some mesothelioma doctors prescribe additional chemotherapy drugs to combat disease progression after initial treatment. A 2021 study published in The Lancet highlights the benefits of using Gemzar (gemcitabine) as a second-line treatment for malignant mesothelioma.
Clinical trials for mesothelioma show that a combination of cisplatin and Alimta is often the best chemotherapy for first-line mesothelioma. Emerging research published in JAMA Oncology indicates that adding pegargiminase to this combination increased both progression-free and overall survival of study participants.
Drug combinations may also be effective for heated chemotherapy used in surgery. Common choices are cisplatin, doxorubicin and mitomycin C. Some chemotherapy drugs have contraindications, so it’s important to discuss your overall goals and health history with your doctor before undergoing treatment.
Combining Chemotherapy With Other Mesothelioma Treatments
Many doctors recommend a multimodal approach to treating mesothelioma, combining different treatments. A recent review of multimodal approaches shows they improve overall survival rates and treatment effectiveness.
Oncologists may use chemotherapy before, during or after surgery to remove tumors. The relationship between chemotherapy and surgery is important for the treatment of mesothelioma.
“There are some very large ongoing clinical trials looking at combining both chemotherapy and immunotherapy together as a first treatment option,” Suga said. “I think cancer treatments, especially for mesothelioma, are evolving, and there’s some exciting things on the horizon.”
Immunotherapy combined with chemotherapy may offer benefits such as longer periods before progression and higher overall survival rates at established checkpoints. The combinations of durvalumab (anti-PD-L1 antibody) with cisplatin and Alimta and pembrolizumab with pemetrexed-platinum chemotherapy both resulted in statistically longer survival times compared to chemotherapy alone.
Another novel mesothelioma treatment approach is the use of Tumor Treating Fields. Application of electric fields disrupts tumor cell growth. A 2023 study tested the effects of TTFields administered with standard chemotherapy for mesothelioma. Results showed that the combination therapy resulted in reduced cell growth compared to stand-alone treatments.
When I first speak with patients, they have a misunderstanding of what side effects to expect from chemo. A lot of people still think hair loss and vomiting. Explaining what most patients experience after chemo or immunotherapy infusion is talked about a lot.
Side Effects of Chemotherapy for Mesothelioma
While chemotherapy is the most effective treatment for malignant mesothelioma, side effects are common. Some can be severe. Drug interactions can make side effects worse or lessen the effectiveness of your medications. It’s crucial to discuss any medications or alternative therapies you take with your doctor when beginning chemotherapy for mesothelioma.
Some patients may think side effects indicate that treatment is or isn’t working. Dr. Raja Mudad, medical director of the chemotherapy treatment unit at the Sylvester Comprehensive Cancer Center in Miami, explained that this isn’t the case. “There is absolutely no relationship between effectiveness and side effects,” he told The Mesothelioma Center at Asbestos.com.
Common Side Effects
Chemo Brain: Many chemo patients experience varying degrees of memory loss or confusion. Chemo brain can be short-lived or last for years.
Diarrhea and Constipation: Chemo drugs often irritate the gastrointestinal tract lining. Peritoneal mesothelioma patients may be more susceptible to damage.
Fatigue: Exhaustion sometimes lasts all day. It can impact nearly all chemotherapy patients. It may even result in depression or insomnia.
Hair Loss: Hair cells divide rapidly and so are very susceptible to damage from chemo drugs. Hair loss is one of the most common side effects.
Low Blood Counts: Chemotherapy can decrease blood cell counts. This may lead to a weakened immune system, fatigue and diminished ability to form blood clots.
Mouth Sores: Chemotherapy drugs can damage cells inside the mouth. This causes problems with a patient’s teeth and gums, including painful sores.
Nausea and Vomiting: About 70% to 80% of chemo patients experience nausea and vomiting during therapy. Some experience it several days later.
Rare but serious side effects are also possible. Intense headaches, unexplained bruising or shortness of breath could indicate a reaction to the chemotherapy drugs. A high fever could also be a sign of an infection that requires additional treatment.
Albert Schwartz
Verified Asbestos.com Survivor
Brothers Share Chemo Experience
Albert Schwartz was going to start more chemo when his brother, Ron, was diagnosed with lymphoma. For 3 months they scheduled their infusions together. “Chemotherapy is a weird thing to describe to people who never lived it,” he says. “At times you just don’t feel right, but it’s hard to always pinpoint why. Your body just gets out of sorts. My brother was the only one who could relate. It took our relationship to another level.”
How You Can Manage Chemotherapy Side Effects
Managing side effects from chemotherapy for mesothelioma can keep them from negatively impacting your quality of life. Talk to your doctor about possible options, such as altering your treatment regimen.
Tips for Managing Side Effects
Ask About Nutrition: Pemetrexed lowers the body’s folic acid and B12 levels. Talk to your doctor about your nutritional needs or supplements to maintain nutrient levels.
Journal: Record any new or changing side effects with the date, intensity and any remedies that help.
Openly Communicate: Don’t try to “tough it out” for fear of missing a chemo cycle. Communicate honestly with your doctor to prevent complications.
Over-the-counter and prescription medications, including Aloxi, Emend and Zofran, may help reduce the nausea and vomiting that are common with chemotherapy. Palliative care specialists can also provide guidance and care to reduce pain and promote comfort during your treatment.
Free Mesothelioma Nutrition Guide
Eating the right diet throughout mesothelioma treatment can ease your symptoms.
Developing a plan before starting chemotherapy can help you avoid feeling overwhelmed. Enlist your family, friends and care providers to help with this process. It can also be helpful to talk to the staff at your treatment center about what to expect during treatment and any tips they have to help you prepare.
Most dual-drug chemotherapy treatments take several hours to administer. You may need a break between the two to help manage side effects.
Tips to Prepare for Chemotherapy
Ask for Assistance. Ask family and friends to help you at home and work. Extreme fatigue often follows chemotherapy treatment and you may need their help.
Schedule a Dental Checkup. You may need a dental visit to check for signs of infection. Treatment of dental disease reduces the risk of complications during chemotherapy.
Prepare Your Home. Eliminate areas where you can injure yourself at home, such as sharp corners or tripping hazards. Wash and cook food thoroughly to reduce infection risks.
Hair Loss: Hair cells divide rapidly and so are very susceptible to damage from chemo drugs. Hair loss is one of the most common side effects.
Expect Side Effects. Discuss chemotherapy side effects with your oncologist. You may need to pick up prescriptions for side effects before your first treatment.
Complete Preliminary Testing. Blood and heart tests ensure your body can tolerate chemotherapy.
Ready Yourself for Treatment. Eat a light meal, sleep well and plan for a ride to and from your appointments. Drink plenty of liquids to avoid dehydration.
Get Port Placement. Systemic chemotherapy is usually delivered through a port, catheter or pump surgically placed into a large vein.
Once your session is finished, you’ll need time to rest. Your body is weakened during this time and you’ll need to avoid others with illnesses. Careful exercise, proper rest and a balanced diet can help strengthen your body during chemotherapy. Post-chemo self-carepractices include maintaining oral hygiene to avoid sores, preventing infections and learning how to take care of any medical devices or ports.
Common Questions About Mesothelioma Chemotherapy
Is chemotherapy effective for pleural and peritoneal mesothelioma patients?
Combining chemotherapy with another modality is the most effective treatment for all types of mesothelioma. Chemo drugs pemetrexed (Alimta) and cisplatin after surgery can extend survival for pleural mesothelioma. For peritoneal mesothelioma, patients eligible for surgery undergo a heated chemotherapy treatment applied during the operation.
How much does chemo cost?
Chemotherapy is expensive and can cost an average of $10,000 per month. However, Medicare and other insurance plans typically cover much of the cost. Studies have shown that cancer treatment is less effective when patients struggle to afford it. Many cancer patients rely on financial assistance during treatment, and mesothelioma patients are no exception.
Please do not hesitate to discuss finances with your doctors and their staff. They may be able to recommend options for financial assistance such as treatment grants, Social Security Disability Insurance, VA claims, asbestos trust fund claims and mesothelioma claims.
How can chemo impact a patient’s mental health?
As many as 25% of cancer patients feel depressed during and after chemotherapy. Counselors, support groups, antidepressant medications and meditation can help patients manage these psychological effects of chemotherapy.
Some physical side effects, such as hair loss and fluctuations in weight, can cause mesothelioma patients to struggle with self-esteem, leading to depression and other mental and emotional side effects.
Can I work during chemotherapy treatment?
Your ability to work during mesothelioma chemotherapy treatment will depend on your individual experience with side effects and the demands of your job. If you have only mild side effects tolerated with a prescription or over-the-counter medication, you may be able to return to work.
However, your doctor may not clear you for work if your job involves heavy labor or risks of injury or infection. These hazards could cause severe harm while on chemotherapy. Always discuss your plan for returning to work with your doctor before taking action.
How often will I need to undergo chemotherapy sessions?
The frequency of chemotherapy sessions for mesothelioma can vary depending on the patient’s treatment plan. In general, chemotherapy is administered in cycles. One cycle is a treatment every three or four weeks. Rest periods in between allow the body to recover. Some patients require only a few months of therapy, while others stay on for a year or more.
The length and number of cycles can vary depending on the type and stage of mesothelioma and the chemotherapy drugs used. Treatment plans may be adjusted based on the patient’s response to chemotherapy and any side effects they experience. Discussing your specific treatment plan and chemotherapy schedule with your medical team is best.
Are there any alternative or complementary treatments that can be used alongside chemotherapy for mesothelioma?
Some complementary treatments can be used alongside chemotherapy for mesothelioma. These treatments can help manage symptoms and improve quality of life. Some examples include acupuncture, massage therapy and yoga. Acupuncture is a traditional practice involving thin needles inserted into specific points on the body. It may alleviate pain, nausea and other symptoms.
Massage therapy can help reduce stress and pain and improve range of motion. Yoga combines physical postures, breathing techniques and meditation to improve overall well-being. Alternative or complementary options should not replace standard medical treatment for mesothelioma. Always talk to your doctor before starting any new therapies. They can help you decide which options are safe and appropriate for you.
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Landau, D. (2024, August 7). Chemotherapy for Mesothelioma Patients. Asbestos.com. Retrieved November 14, 2024, from https://www.asbestos.com/treatment/chemotherapy/
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Landau, Daniel. "Chemotherapy for Mesothelioma Patients." Asbestos.com, 7 Aug 2024, https://www.asbestos.com/treatment/chemotherapy/.
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Landau, Daniel. "Chemotherapy for Mesothelioma Patients." Asbestos.com. Last modified August 7, 2024. https://www.asbestos.com/treatment/chemotherapy/.
A medical doctor who specializes in mesothelioma or cancer treatment reviewed the content on this page to ensure it meets current medical standards and accuracy.
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Dr. Jacques Fontaine is a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida, where he heads up the Mesothelioma Research and Treatment Center. He specializes in minimally invasive robotic surgery and aggressive surgeries for mesothelioma.
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