Chemotherapy for mesothelioma

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most people with mesothelioma have chemotherapy. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• relieve pain or control the symptoms of advanced mesothelioma (called palliative chemotherapy)
• shrink the amount of mesothelioma in the body before surgery (called neoadjuvant chemotherapy)

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells. Chemotherapy may also be a regional therapy, which means that it is given to a specific area of the body. It may be given into the abdomen for peritoneal mesothelioma.

The most common chemotherapy drug combinations used to treat pleural mesothelioma are:

• cisplatin and pemetrexed (Alimta)
• cisplatin and raltitrexed (Tomudex)
• pemetrexed and carboplatin (Paraplatin, Paraplatin AQ) – may be offered to people who have other health problems and can’t be given cisplatin
• cisplatin and gemcitabine (Gemzar)

Chemotherapy drugs that are used alone to treat pleural mesothelioma are:

• pemetrexed
• vinorelbine (Navelbine)

If mesothelioma does not respond to drugs used in earlier treatments or if it comes back after treatment, the following drugs may be used:

• pemetrexed (if not used before)
• vinorelbine
• gemcitabine

Before chemotherapy with pemetrexed is started, your healthcare team will give you vitamin B12 and folic acid supplements. These can help reduce some of the harmful side effects of the drug. 

Chemotherapy for peritoneal mesothelioma is given as a regional therapy, which means that it is given directly into the peritoneal cavity. This is called intraperitoneal chemotherapy. When the drugs are heated before they are put into the body, it is called hyperthermic intraperitoneal chemotherapy.

After surgery is done to remove as much of the cancer as possible from the abdomen, the heated chemotherapy drugs are put directly into the peritoneal cavity through the cut (incision) in the abdomen. The surgeon moves the drugs around the cavity by hand so that they can come into contact with and treat all of the surfaces that may have cancer cells on them that can’t be seen. After this has been done, the surgeon closes up the cut. The chemotherapy drugs are left in the body where they are slowly absorbed.

If a person isn’t well enough to have surgery, then chemotherapy is given through a thin tube (catheter). The surgeon places a special pump attached to the tube just under the skin. One end is put inside the peritoneal cavity and the other end is left outside of the body. Chemotherapy drugs are put into the peritoneal cavity through the catheter. You will be told to change positions a number of times to make sure that the chemotherapy drugs come into contact with all of your peritoneal cavity. The drugs are absorbed by your body during this time.

The most common chemotherapy drugs used for intraperitoneal chemotherapy are:

• cisplatin
• mitomycin (Mutamycin)
• doxorubicin (Adriamycin)

Sometimes cisplatin is combined with either mitomycin or doxorubicin.

Systemic chemotherapy is usually not used for peritoneal mesothelioma because it hasn’t been shown to be very effective.

Intraperitoneal chemotherapy may be done again if peritoneal mesothelioma comes back (recurs) after treatment.

Side effects can happen with any type of treatment for mesothelioma, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for mesothelioma are:

• low blood cell counts
• fatigue
• nausea and vomiting
• diarrhea
• nervous system damage
• abdominal pain
• sore mouth and throat
• skin rash
• loss of appetite

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.