Mesothelioma Medications

What Are Mesothelioma Drugs?

Many types of anti-cancer drugs treat mesothelioma with varying success. Traditional chemotherapy remains the most effective option. Ongoing trials test other drugs for better mesothelioma treatments.

FDA-Approved Medications for Mesothelioma

• Pemetrexed (Alimta)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

Patients may try drugs not approved by the U.S. Food and Drug Administration in clinical trials and compassionate-use programs.

Doctors may use these drugs with surgery and radiation therapy. This combination approach is called multimodal therapy. It attacks the cancer in multiple ways to maximize the chance of killing cancer cells and shrinking tumors.

All anti-cancer drugs are a form of chemotherapy. Other anti-cancer drugs block the growth and spread of malignant cells.

Chemotherapeutic Medications

Chemotherapy is one of the most common treatments for any cancer, including mesothelioma. Despite its side effects, chemo is one of the best mesothelioma treatments. These drugs seek out and kill rapidly dividing cells, including cancer ones.

Common Chemotherapy Medications for Mesothelioma

• Cisplatin
• Pemetrexed (Alimta)
• Carboplatin
• Navelbine
• Gemcitabine
• Doxorubicin
• Raltitrexed

A mix of cisplatin and pemetrexed is best for most mesothelioma patients. This combo is the most common first-line treatment for mesothelioma. Second-line chemotherapy may be an option if the drugs are not tolerated or effective. Second-line chemotherapy drugs include carboplatin, gemcitabine, vinorelbine (Navelbine) and doxorubicin.

Most chemotherapy drugs are synthetic. Navelbine is semi-synthetic. Part of that drug comes from a flowering plant known as the periwinkle. Patients get Navelbine alone or with another chemo drug like cisplatin.

Common Side Effects of Chemotherapy Drugs

Common side effects of chemotherapy drugs for mesothelioma inlcudes stomach pain, nausea and irregular stools. There are medications to control these side effects.

Typical Side Effects of Mesothelioma Chemotherapy Drugs

• Bleeding
• Bruising
• Fatigue
• Hair Loss
• Impaired vision or hearing
• Nausea

Patients should contact their physician immediately if they develop side effects like fever, chills, a rash, swollen ankles and blood in their urine.

Drug-to-Drug Interactions

The kidneys clear chemo drugs from your blood and prevent toxicity. The chemotherapy drugs pemetrexed, cisplatin and carboplatin may harm your kidneys. This risk increases if you take some medications at the same time, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve).
• Certain antibiotics like vancomycin (Vancocin), neomycin and gentamicin (Gentak).
• Antiviral and antiretroviral drugs such as foscarnet (Foscavir), tenofovir (Viread) and atazanavir (Retataz).
• Certain osteoporosis drugs like as zoledronate (Zometa, Reclast).

This list is not all-inclusive. The safest thing is to ask the doctor who prescribed the chemotherapy. They will know what medications are safe to take during treatment.

Alert your doctor right away if you have kidney damage symptoms. Signs include little or no urination, a swollen abdomen and rapid weight gain.

Other drugs can be dangerous for mesothelioma patients on chemo. Vitamin B6 supplements and some seizure drugs can interact negatively with cisplatin.

Chemotherapy patients should not get live vaccines. Examples are the shingles vaccine and the nasal flu vaccine. The injectable flu shots have inactivated virus particles. Your doctor may advise you to have that injection yearly.

Immunotherapy Drugs

Immunotherapy agents enhance a mesothelioma patient’s immune system and help the body attack cancer cells. The immune system often fails to see cancer cells as unhealthy. However, with the addition of immunotherapy medications, the immune system may begin fighting the cancer.

Interferons and interleukin-12, two types of proteins, also have been studied for the treatment of malignant mesothelioma.

CRS-207

CRS-207 is an immunotherapy vaccine made from a bacterium. In 2016, preliminary results showed that 94% of participants responded to the drug. Tumor shrinkage occurred for 85% of participants, and 35% saw no new tumor growth.

Amatuximab

Amatuximab (MORAb-009) is an immunotherapy drug tested on mesothelioma patients. Despite promising results in the phase I trial, the phase II trial failed to warrant further study. The overall median survival was 14.8 months. A 2021 study of Amatuximab found it inhibited cancer cells in the peritoneum.

SS1P

A phase I study of SS1P in people with pleural mesothelioma has reported a partial tumor response in 12 of 20 participants. Immunotherapy drugs are appealing because they have milder side effects than chemotherapy.

Targeted Therapy Drugs

Targeted therapy is a growing area for mesothelioma treatment. It targets specific molecular changes in cancer cells that drive their growth, spread and death. Chemotherapy affects both healthy and cancerous cells. Doctors design targeted therapy to kill only cancerous cells.

NGR-hTNF

NGR-hTNF is a targeted therapy drug. It is in phase III trials to test its use in managing recurring mesothelioma. In the phase II trial, overall survival was 12 months in patients who had been treated with pemetrexed chemotherapy. The phase III trial is ongoing. Some patients have an 11.7-month overall survival, per current data. This preliminary data offers hope for more effective second-line therapy for recurring mesothelioma that will buy patients more time.

Ganetespib

This drug blocks heat shock protein 90, which helps mesothelioma cells grow. A phase I and II trial of ganetespib in pleural mesothelioma patients is ongoing in the U.K. It tests ganetespib as a maintenance therapy after a combination of it and chemotherapy.

Tazemetostat

This drug targets EZH2, an enzyme that helps mesothelioma cells grow. The drug works best in patients with a BAP-1 gene mutation, which appears in 60% of mesothelioma cases. Two trials are testing tazemetostat in mesothelioma patients. The first accepts participants with or without the BAP-1 mutation. The second only includes mesothelioma patients with a BAP-1 mutation.

Onconase

Another form of targeted therapy tested in clinical trials on mesothelioma patients is ranpirnase (Onconase). The drug is among the few therapies progressing to a phase III clinical trial. Though early results were promising, a phase IIIb trial found that Onconase failed to improve survival enough for the FDA to approve it.

After the Onconase trials, mesothelioma researchers, including Dr. Michele Carbone and Dr. Harvey Pass, studied mesothelioma cell lines in 2011. They wanted to see if Onconase would work better in patients with low Akt enzyme levels. The study suggests Onconase may help that group a bit. But, no further studies have tested this in humans.

Another study tested Onconase and an anti-malarial drug in test tubes and mice with mesothelioma. This 2016 Chinese study showed a significant decrease in tumors and an anti-angiogenesis effect. Further research is necessary to test this effect in humans.

Anti-Angiogenesis Drugs

Scientists are still looking for drugs to prevent angiogenesis, which is the body’s way to heal by creating new blood vessels. But the process also builds vessels to tumors. It feeds them with fresh blood, allowing them to grow and spread.

Researchers believe stopping this process may be the key to halting mesothelioma’s aggression and the spread of other cancers. Angiogenesis is also needed for metastasis, the spread of cancer cells to other body parts.

Drugs that block new blood vessel growth toward tumors are called anti-angiogenesis drugs or angiogenesis inhibitors. An example of an anti-angiogenesis agent is bevacizumab. Without blood vessels to bring nutrients, the cancer cells will die. They cannot divide and spread without them. Stopping angiogenesis is not the hard part. The hard part is stopping angiogenesis related to cancer without hindering the natural ability to heal itself. This challenge is tough and is at the center of considerable research.

Combined with other treatments, such as chemotherapy and radiation, angiogenesis inhibitors are extending life among certain mesothelioma patients in clinical trials. They don’t seem to work consistently in everyone, but some mesothelioma patients have lived years longer because of these drugs. For example, Avastin, thalidomide, sorafenib and cediranib have improved survival rates for certain mesothelioma patients in clinical trials.

Avastin

Prior studies of Avastin, or bevacizumab, in mesothelioma trials had mixed results. Some patients responded well, others not at all. A 2015 French study tested the drug on hundreds of mesothelioma patients, using it with chemotherapy. It reported an overall survival of 18.8 months. Average survival is around 12 months with chemotherapy alone.

How Do These Drugs Work?

Angiogenesis occurs via a complex signaling process where cells use proteins to communicate. Anti-angiogenesis drugs interfere with this process in one of three ways, each corresponding to a specific step of the cascade. These drugs are a type of targeted therapy.

The first step of angiogenesis makes room for new cells on the outer lining of blood vessels. They are called endothelial cells. In this step, endothelial cells break down placeholder material surrounding the cells, called the extracellular matrix.

Cancer cells trigger this process to create space for a new blood vessel to branch off an existing one toward a tumor. Anti-angiogenesis drugs stop this process. New cells have no room to form blood vessels, preventing the angiogenesis cascade.

Side Effects of Anti-Angiogenesis Drugs

Anti-angiogenesis drugs tend to cause fewer and milder side effects than chemo. On the other hand, chemotherapy drugs attack quickly dividing cells, even if they are healthy. But anti-angiogenesis drugs do not affect most healthy cells.

The downside is that because angiogenesis occurs when wounds are healing, these drugs complicate the healing process and may lead to excessive bleeding. Patients may also develop blood clots, internal bleeding or a hole in the digestive tract.

Angiogenesis-targeting therapies have a low risk of major side effects. They show promise in preventing mesothelioma from spreading.

Photodynamic Therapy Drugs

Photodynamic therapy is a two-step treatment. It uses drugs to make cancer cells sensitive to light and then light to destroy them. For mesothelioma, the photosensitizer is almost always porfimer sodium (Photofrin). It is also used for other cancers like esophageal cancer.

Researchers are testing photodynamic therapy in pleural mesothelioma patients. They found it improves survival times. The treatment is still in development for peritoneal mesothelioma while doctors search for an effective means of administering light to the abdominal cavity. The therapy commonly causes light sensitivity for about six weeks, possibly resulting in burning, swelling or scarring.

The Future of Mesothelioma Drugs

The landscape of new mesothelioma treatments is constantly evolving.

Oncologists say that personalized treatment is the future of cancer care. The one-size-fits-all approach is a thing of the past. In the future, doctors will use your genes, tumor DNA and blood biomarkers. They will find which drugs will target your cancer.

Advice From a Mesothelioma Survivor

Before starting any medication, discuss it thoroughly with your mesothelioma oncologist. Ask these questions:

• What side effects have patients experienced on that drug?
• Is there an option for a reduced dose if adverse effects are too much?
• Will a particular medication disqualify you from other treatments or trials?
• What’s the backup plan if the drug doesn’t work?

More participants are needed in mesothelioma trials to get the research we need. Consider talking to your oncologist about which trials suit you.

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