Chemotherapy for Mesothelioma Patients

How Chemotherapy Treats Mesothelioma

Chemotherapy drugs travel through the bloodstream to reach mesothelioma cancer cells. They enter these cells and damage the DNA or interfere with the cellular machinery that controls cell division and growth. This damage stops the cells from multiplying and triggers their death.

Key Facts About Chemotherapy for Mesothelioma

1. The standard treatment for malignant pleural mesothelioma is a combo of Alimta (pemetrexed) and Platinol (cisplatin). Patients who can’t tolerate cisplatin may receive carboplatin.
2. Peritoneal mesothelioma patients benefit from a cytoreduction surgery and heated chemotherapy combination.
3. Chemotherapy cycles last about 3-4 weeks.

Doctors use chemo as an effective first-line treatment to kill mesothelioma cancer cells. However, the drugs can also harm healthy cells. The drugs you receive depend on your mesothelioma diagnosis. 

Chemo is sometimes used with other targeted therapies to treat mesothelioma. Doctors also use chemo to reduce tumor size and relieve pressure-related symptoms.

“In general, chemotherapy drugs disrupt the division of cells that divide quickly. This prevents cancer cells from replicating and growing.”

Dr. Jennifer M. Suga, oncologist at Kaiser Permanente Medical Center

How Do Chemotherapy Drugs Effectively Treat Mesothelioma?

Chemotherapy drugs treat mesothelioma by surrounding the cancer cells. Next, the drugs enter the cancer cells and damage the control center that makes the cells divide. Once the cells cannot divide and spread to other parts of the body, the chemotherapy drugs kill them.

Chemotherapy Drugs Used for Mesothelioma 

Alimta is the standard chemo drug for mesothelioma. Doctors often give Alimta with cisplatin through an IV 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 in The Lancet shows that Gemzar (gemcitabine) helps as a second-line treatment for mesothelioma. 

Common Mesothelioma Chemotherapy Drugs

• Carboplatin
• Cisplatin
• Cyclophosphamide
• Doxorubicin
• Gemcitabine (Gemzar)
• Pemetrexed (Alimta)
• Raltitrexed
• Vinorelbine

Clinical trials for mesothelioma show that a combo of cisplatin and Alimta is often the best first-line chemo. Emerging research in JAMA Oncology shows that adding pegargiminase to this combo improved survival in study participants. It increased both progression-free and overall survival.   

Drug combinations may also work for heated chemotherapy used in surgery. Common choices are cisplatin, doxorubicin and mitomycin C. Some chemo drugs have contraindications, so it’s important to discuss your goals and health history with your doctor before treatment. 

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How Is Chemotherapy Administered?

Mesothelioma chemotherapy is delivered in two main ways depending on where tumors first develop and how far they spread in the body. Systemic chemotherapy circulates throughout the body via the bloodstream to reach cancer cells wherever they spread. Localized chemotherapy delivers concentrated, heated drugs directly to affected areas during surgery to target remaining cancer cells after tumor removal.

Systemic Chemotherapy Delivery

Systemic chemo circulates through your bloodstream to reach cancer cells throughout your body. If your doctor recommends a systemic approach, you’ll receive these drugs via an IV, a port or as a pill you’ll swallow.

How Systemic Chemo Is Administered

• IV line: A needle is inserted into a vein in your arm or hand for each treatment session. You’ll typically visit an infusion center every 21 days, with each session lasting several hours.
• Oral pills: You’ll take chemo medication at home in pill form. This method is less common for mesothelioma but may be used in clinical trials of new drugs.
• Port: A small device is surgically placed under your skin and connected to a vein. The port allows repeated medication delivery without multiple needle sticks, making treatment more comfortable.

The most common drug combination for mesothelioma is Alimta (pemetrexed) with cisplatin, given on day 1 of each cycle. Treatment cycles include an active treatment period and a rest period for recovery.

Localized Chemo Delivery

Localized chemo delivers drugs directly into your chest or abdominal cavity during or after surgery. This approach targets mesothelioma cancer cells while limiting damage to healthy tissue.

How Localized Chemo Is Administered

• HIPEC: Hyperthermic intraperitoneal chemo for peritoneal patients circulates a heated solution throughout the belly with an infusion pump right after tumor-removing surgery.
• HITHOC: Hyperthermic intrathoracic chemo for pleural patients applies a heated solution directly to the chest cavity after tumor removal.
• NIPEC: Normothermic intraperitoneal chemo for peritoneal patients, delivers room-temperature chemo via a port placed during surgery. Treatment begins 4 to 6 weeks after surgery and is repeated every 3 weeks, up to 6 times.
• PIPAC: Pressurized intraperitoneal aerosol chemo for peritoneal patients delivers a pressurized mist of drugs into the belly through small incisions.

Research shows heated chemotherapy following surgery is an effective treatment approach. A 2023 study in the Turkish Journal of Thoracic and Cardiovascular Surgery found it is “a preferable and tolerable method in the treatment of malignant pleural mesothelioma.”

Combining Chemotherapy With Other Mesothelioma Treatments

Chemo is often combined with other mesothelioma treatments like surgery, immunotherapy and radiation because using multiple approaches together improves survival rates and treatment effectiveness. This strategy is called multimodal treatment. For example, oncologists may use chemotherapy before, during or after surgery to remove tumors.

Combining Chemo With Surgery

• Chemo before surgery: Called neoadjuvant chemo, this shrinks tumors prior to surgery, making them easier for your surgeon to remove.
• Chemo with surgery: Known as intraoperative chemo, this is localized chemo like HIPEC that is done as the second step in a 2-step procedure, immediately after tumors are removed to ensure any remaining cancer cells are destroyed.
• Chemo after surgery: Given within a few weeks to months after surgery, adjuvant chemo can destroy remaining cancer cells and lower the chance of recurrence.

Combining chemo with immunotherapy shows promise for people with mesothelioma. Pairing Imfinzi (durvalumab) with cisplatin and Alimta (pemetrexed) has led to longer survival than chemo alone. Following a clinical trial that showed improved survival, the FDA approved Keytruda (pembrolizumab) with pemetrexed-platinum chemo as first-line treatment for inoperable pleural mesothelioma in September 2024.

“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.”

Chemo also often pairs with radiation therapy when surgery isn’t an option. Researchers continue exploring innovative combinations, including a 2023 study testing Tumor Treating Fields with standard chemo, which reduced mesothelioma cell growth more than either treatment alone.

Survivor Story

Epifanio Figueroa: How have you felt since receiving chemotherapy for your mesothelioma treatment?

View Transcript

Since my last chemo, what the doctor recommended that I had a regular check every six months.

And so we started doing that. And every time consecutively that we went, the tumors in my body were diminishing.

To the point that, the last time that I went, the doctor says we can’t see almost anything there.

So, and I feel great. I feel that I never went through it. My feeling is right now that I have never gone through it.

I forgot all the pain and all the suffering. And I feel like I’ve never been through it, but I know I have, but it’s gone. It’s just passed.

I tell the rest of the people that are seeing me, I’m telling them that they have to what they went through, just sweep it under the rug and forget about it. Because it’s not good to going through all of that suffering again.

And I’m fine. You know, and I’m doing… it’s been a life changer for me because now I realize that I can do many things afterwards.

Now I do more things now that I’m an older person than I was when I was young.

So to all my buddies that have mesothelioma, once you get off the treatment, sweep that under the rug and keep on going forward.

Mesothelioma Chemotherapy Side Effects

Chemotherapy for mesothelioma may cause side effects such as hair loss, fatigue and chemo brain. Drug interactions can worsen side effects or weaken medications. It’s crucial to discuss any medications or alternative therapies you take with your doctor when beginning chemotherapy for mesothelioma.  

Common Side Effects

• Chemo Brain: Many chemo patients have memory loss or confusion. Chemo brain can be short-lived or last for years.
• Diarrhea and Constipation: Chemo drugs often irritate the gut lining. Peritoneal mesothelioma patients may be more prone 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 lower blood cell counts. It may weaken the immune system, cause fatigue and impair blood clotting.
• Mouth Sores: Chemotherapy drugs can harm the cells in the mouth. It harms a patient’s teeth and gums, causing painful sores.
• Nausea and Vomiting: About 70% to 80% of chemo patients get nausea and vomiting during therapy. Some experience it several days later.

Rare but severe side effects are also possible. Intense headaches, unexplained bruising or shortness of breath may signal a reaction to the chemo drugs. A high fever could also mean an infection needing more treatment.

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.

Danielle DiPietro, Patient Advocate and VA-Accredited Claims Agent

How You Can Manage Chemotherapy Side Effects

It’s vital to manage the side effects of chemotherapy for mesothelioma to preserve your quality of life. Talk to your doctor about options like changing your treatment.  

Tips for Managing Chemo 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 new or changing side effects. Note the date, their intensity and any remedies that help.
• Openly communicate: Don’t try to “tough it out” for fear of missing a chemo cycle. Be honest with your doctor to avoid complications.
• Preventing nausea: Over-the-counter and prescription drugs, like Aloxi, Emend and Zofran, may help. They can reduce nausea and vomiting from chemotherapy.
• Stay active: Light exercise like short walks can reduce fatigue and boost your mood.

Palliative care specialists can also provide guidance and care to reduce pain and promote comfort during your treatment. They work as part of a team to manage symptoms and improve quality of life at all stages of mesothelioma care.​

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How to Prepare for Mesothelioma Chemotherapy

Making a plan before starting chemotherapy can help. A plan can prevent you from feeling overwhelmed. Ask your family, friends and care providers to help. Ask the treatment center’s staff what to expect during treatment and for any tips on preparing. 

Most dual-drug chemo treatments take several hours to administer. You may need a break between the two to help manage side effects.  

Tips to Prepare for Chemotherapy

1. Ask for help. Request assistance from family and friends at home and work. Extreme fatigue often follows chemotherapy treatment, and you may need support with daily tasks.
2. Get medical clearance. Your doctor will order blood and heart tests to check if your body can handle chemotherapy. You may also need a dental visit to identify and treat any infections, which lowers the risk of complications.
3. Have a port placed. Systemic chemotherapy is usually delivered through a port, catheter or pump surgically placed into a large vein before treatment begins.
4. Safety-proof your home. Remove potential hazards like sharp corners and trip risks. Wash and cook food thoroughly to reduce infection risks.
5. Pack a comfort bag. Bring items that will help you stay comfortable and occupied during treatment sessions, which can last several hours.
6. Prep the day before your appointment. Eat a light meal, get adequate sleep and arrange transportation to and from your appointments. Drink plenty of fluids to stay hydrated.
7. Practice post-treatment self-care. Maintain oral hygiene to prevent mouth sores, follow infection prevention protocols and learn how to care for any medical devices or ports.

Once you finish your session, your immune system will be compromised. This is a critical time for rest and recovery. You’ll need to avoid close contact with anyone who may be contagious or showing symptoms of illness. Exercise, rest and a balanced diet can help strengthen your body during chemo. 

Common Questions About Mesothelioma Chemotherapy

Is chemotherapy effective for pleural and peritoneal mesothelioma patients?

The best treatment for all mesothelioma types is to combine chemotherapy with another method. 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?

According to chemotherapy statistics, it’s expensive and can cost an average of $10,000 per month. But Medicare and other insurance plans cover most of the cost. Financial barriers can prevent cancer patients from receiving effective treatment. Studies show patients facing affordability challenges may experience delays in diagnosis, have difficulty adhering to treatment plans, or be forced to forgo treatment altogether, leading to poorer outcomes.

Many cancer patients rely on financial help during treatment. Mesothelioma patients are no exception. Patient Advocates can help patients gain access to financial assistance.

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, antidepressants and meditation can help. They can manage the emotional impact of chemotherapy.

Some side effects, like hair loss and weight changes can hurt patients’ self-esteem. This can lead to depression and other mental issues.

Can I work during chemotherapy treatment?

Whether you can work during chemo for mesothelioma depends on your individual experience. If your side effects are manageable and your job isn’t physically demanding or inherently risky, you may be able to continue working. Discuss your specific situation and job requirements with your doctor to determine the best course of action. 

How often will I need to undergo chemotherapy sessions?

The frequency of chemo for mesothelioma can vary. It depends on your treatment plan. In general, doctors administer chemotherapy in cycles. A cycle is a treatment every 3 or 4 weeks. Rest periods in between allow your body time to recover. Some people require only a few months of therapy, while others stay on for a year or more.

Are there any alternative or complementary treatments that can be used alongside chemotherapy for mesothelioma?

Some complementary treatments can be used with chemotherapy for mesothelioma. These treatments can help manage symptoms and improve quality of life. Some examples are acupuncture, massage therapy and yoga. Acupuncture is a traditional practice involving thin needles inserted into specific points on the body. It may ease pain, nausea and other symptoms.

How does chemotherapy affect mesothelioma life expectancy?

Compared to an average life expectancy of 4 to 12 months without treatment, people who receive chemo for mesothelioma typically live for 12 to 21 months. Chemo, particularly when combined with surgery or other therapies, can significantly extend survival and improve the quality of life for those with this cancer. It’s important to note patients with earlier stage disease or peritoneal mesothelioma may experience considerably longer survival times.