Mesothelioma Chemotherapy | Chemo Treatments & Options


Mesothelioma chemotherapy is a versatile treatment option for pleural mesothelioma and peritoneal mesothelioma patients. Despite the side effects that occur with most therapies, more than 70 percent of cancer patients choose chemotherapy to slow down tumor growth, relieve symptoms, or support surgical treatment.

Chemotherapy is a common treatment for malignant mesothelioma used to kill cancer cells and prevent their reproduction. Mesothelioma chemotherapy is can be used alone or in combination with surgery. The researchers continue to investigate the efficacy of new applications and chemotherapy drugs.

Chemotherapy attack rapidly dividing cells and make them an effective means of killing cancer cells and shrinking tumors for many mesothelioma patients. Although chemotherapy can not cure mesothelioma itself, it can relieve symptoms, improve quality of life and prolong survival. Doctors may also use it in combination with surgery, radiotherapy or a newer technology such as immunotherapy or photodynamic therapy.
Mesothelioma Chemotherapy
With multiple medications, dosage levels, and methods of administration, cancer specialists can tailor chemotherapy to the circumstances of each patient, which is why it remains the most common form of mesothelioma treatment. Undoubtedly, chemotherapy can be a terrifying treatment. Because the drugs attack all rapidly dividing cells in the body, both cancerous and healthy, this treatment often has severe side effects such as hair loss, vomiting, fatigue, and fever. According to the 2016 study using data from the Surveillance, Epidemiology and End Results (SEER) database, the potential benefits of chemotherapy for mesothelioma patients are significant.

Systemic Chemotherapy for Mesothelioma


  • The most common treatment for mesothelioma
  • The first-line drug combination is pemetrexed/cisplatin
  • Oral or intravenous given in pleural mesothelioma
  • Can be heated during surgery for peritoneal mesothelioma and pumped into the abdominal cavity
In pleural mesothelioma, the most common type of cancer, chemotherapy drugs are usually injected from an IV bag into the vein of a patient or swallowed in pill form. This type of treatment is referred to as "systemic chemotherapy" because the drugs enter the patient's bloodstream and affect their entire body.

Systemic chemotherapy drugs are administered cyclically, ie the patient receives a dose every few weeks for a specified number of months. An experienced mesothelioma specialist must consider the patient's stage of cancer and cell type as well as body chemistry and general health to determine the appropriate drug combination, dosage, frequency, and a total number of cycles.

The systemic treatment regimens for chemotherapy vary from patient to patient, but they can be divided into three general categories:

Multimodal therapy: In patients with the previous presentation of a mesothelioma who are healthy enough to withstand aggressive cancer treatment, chemotherapy is often combined with other treatments such as surgery and radiotherapy. reduces the risk of recurrence after surgery.

Chemotherapy alone: Chemotherapy alone can be aggressive. After first-line chemotherapy with the standard drug combination, some patients receive second-line chemotherapy with other drugs.

Palliative chemotherapy: Aggressive cancer treatment is not recommended for patients with late-stage cancer or other complicated medical conditions. Milder chemotherapy, however, can alleviate mesothelioma symptoms for these patients and improve their quality of life.

Researchers are currently developing methods to target chemotherapy drugs to more effectively kill cancer cells while leaving healthy cells intact. Targeted therapy can improve outcomes and reduce side effects, potentially revolutionizing cancer treatment in the future. Currently, however, this experimental technology is only available in clinical trials.

Chemotherapy Process

While chemotherapy procedures vary from patient to patient, here is a typical schedule of what to expect from your first consultation until the end of treatment.


You should discuss the decision to start chemotherapy with your medical team and family. Make sure your diagnosis and blood count have been analyzed by an experienced mesothelioma specialist, and ask your doctors many questions to help you fully understand the pros and cons of chemotherapy. Each person may respond differently to chemotherapy, but if possible, you do not want to be surprised by expected side effects.


Doctors often prescribe medication prematurely to reduce side effects of chemotherapy. Many patients need to have a port, catheter, or pump before they can receive intravenous chemo. Everyone reacts differently to the treatment. So make sure you arrange a ride to and from the first session.


A standard chemotherapy trial for mesothelioma begins with three or four courses administered approximately every three weeks. After taking your vital signs and checking the dosage, a nurse will monitor each treatment. Intravenous combination therapy usually involves 30 minutes of one drug and then up to 2 hours of a second drug. Blood tests are often performed during treatment to ensure optimal efficacy.


Follow-up visits begin several weeks after completion of the entire program. This is the time to ask further questions, gain insight into the treatment and discuss the success or failure of the treatment, and whether further treatments are recommended. Bring a family member to help with the discussion.

Types of Mesothelioma Chemotherapy

Case studies continue to analyze the efficacy of various types of chemotherapeutic and systemic chemotherapy applications, including mesothelioma type, cell type, patient characteristics, and staging.

Mesothelioma Chemotherapy Drugs

Oncologists determine which chemotherapy is best for the patient, taking into account several factors, including side effects. Chemotherapeutics and dosage may be changed if the patient does not respond well to the treatment.

Pemetrexed (Alimta)

Pemetrexed, brand name Alimta, is one of the most widely used chemotherapy drugs for the treatment of mesothelioma and other cancers, such as lung cancer. It is usually used in combination with a platinum-based drug such as cisplatin or carboplatin. 
The drug is injected for administration and patients often receive corticosteroids, vitamin B9 (folic acid) and B12 supplements to combat common side effects. This has shown that patients' life expectancy is often extended by up to several months in many cases.


Cisplatin is a platinum-based chemotherapeutic agent commonly used with pemetrexed and administered by it. Studies have shown that this combination can extend patients' average survival to 12.1 months compared to 9.3 months when used alone. In many cases, cisplatin is used in patients with tumors that can not be surgically removed.


The carboplatin is another platinum-based drug derived from cisplatin in the 1980s. It has not received regulatory approval from the US Food and Drug Administration (FDA) for the treatment of mesothelioma but has other cancers including breast cancer and ovarian cancer. Carboplatin typically has fewer side effects than cisplatin and may, therefore, be a better option for some patients.

Gemcitabine (Gemzar)

Gemcitabine, the brand name Gemzar, is a less common chemotherapy drug that has been relatively effective in mesothelioma chemotherapy studies. This chemotherapy was used as a first-line treatment in combination with a platinum-based drug but was also used as a second-line option for patients who did not respond to other drugs.

Ranpirnase (Onconase)

Ranpirnase, the brand name Onconase, was granted orphan drug designation by the FDA in 2007, meaning it was developed specifically for the treatment of a rare disease. The Ranpirnase is an enzyme that has been shown in clinical studies to effectively kill mesothelioma cells by degrading their RNA. This chemotherapeutic agent is unique in that it targets only cancer cells without harming healthy cells, significantly reducing potential side effects.

Vinorelbine (Navelbine)

Vinorelbine, the brand name Navelbine, is a less widely used chemotherapeutic agent used primarily for the treatment of non-small cell lung cancer but has been shown to be somewhat effective in the treatment of mesothelioma. This drug can trigger apoptosis or programmed cell death in cancer cells. According to the National Comprehensive Cancer Network (NCCN), vinorelbine can be used as a first or second-line mesothelioma therapy because it has not yet been approved by the FDA.

Intraoperative Peritoneal and Pleural Chemotherapy

As an alternative to circulating chemicals in the bloodstream, chemotherapy drugs can be injected directly into the body area where the tumors reside. For peritoneal mesothelioma patients, the combination of this type of chemotherapy with surgery has been established as the best treatment approach.
In hyperthermic intraperitoneal chemotherapy (HIPEC), as much cancer tissue as possible is surgically removed, and then a heated chemotherapy solution is pumped into the abdominal cavity for 60-90 minutes while the patient is still on the operating table.

The high temperature increases the effectiveness of the solution, and the medical staff ensures that it is evenly distributed throughout the abdominal cavity by massaging the area before it is dehydrated and rinsed out. Because the solution is limited to the abdominal cavity, its side effects are minimal.
In 2009, a multicenter study revealed that this multimodal therapy approach could help hundreds of patients for years to diagnose peritoneal mesothelioma. While the historical life expectancy for peritoneal mesothelioma is 12 months or less, patients treated with HIPEC had a mean median survival of 53 months.

"I would do it again without the hesitation," said surviving mesothelioma Jacob Hess, who was diagnosed in 2010. "As it was explained to me, it was an excellent option to accompany the operation, it just made sense, everyone is different and nothing is 100 percent safe, but I have to believe that the clean checkups I get I have a lot to do with HIPEC. "

First-line Mesothelioma Chemotherapy Drugs

In "First-line chemotherapy" offers the approach to the treatment of mesothelioma cancer, which is most likely to benefit others who have been treated for mesothelioma. First-line chemotherapy for pleural mesothelioma is usually a combination of pemetrexed (Alimta) and cisplatin, although doctors may use other drugs depending on a number of factors.

A single drug can be administered to patients who are not healthy enough to act on a combination, although response rates to individual remedies are usually low. Three drug combinations have shown no better results than two-drug combinations.
According to a 2014 study at Shizuoka Cancer Center and Juntendo University in Japan. The pemetrexed/cisplatin combination is likely to remain the standard treatment of choice for patients with inoperable pleural mesothelioma.

Second-line Mesothelioma Chemotherapy Drugs

If first-line chemotherapy shows no positive results, physicians may prescribe second-line chemotherapy. The second round of chemotherapy may involve a similar approach to initial treatment or a completely different combination of drugs.

In addition, in the first round, one of the standard mesothelioma medications will be replaced with a second-line drug in the first round to reduce the toxicity of the combination to the patient. Coplan can be replaced with carboplatin and pemetrexed can be replaced with gemcitabine or doxorubicin.
Other medications used in the treatment of mesotheliomas include onconase, raltitrexed, methotrexate, vincristine, vinblastine, mitomycin, vinorelbine, epirubicin, cyclophosphamide, and ifosfamide.

Side Effects of Mesothelioma Chemotherapy

While radiotherapy and surgery usually only address the site of treatment, the side effects of chemotherapy often affect the entire body of a patient.

Systemic chemotherapy damages all cells in the body that divide quickly. For example, hair follicles are among the fastest growing cells and are easily damaged during treatment so that many cancer patients experience temporary hair loss. Before chemotherapy is considered as a treatment option for mesotheliomas. It is important to familiarize yourself with the usual side effects.
Mesothelioma Chemotherapy


Almost all cancer patients who undergo chemotherapy are affected by fatigue, which makes them feel exhausted.
You can cope with mild tiredness by sleeping well, taking short naps, and doing light exercises regularly. If you have difficulty completing tasks or errands due to fatigue, have friends and relatives help you with simple tasks such as grocery shopping and meal preparation.

If you feel dizzy, dizzy, short of breath, or if your fatigue leads to depression or insomnia, contact your doctor. You may need to adjust your treatment.

Nausea and vomiting

Nausea and vomiting occur in 70 to 80 percent of chemotherapy patients. These symptoms may occur immediately after the administration of the medication or may develop over several days and may disappear within hours or last up to a week.

Patients often struggle to maintain a healthy weight while fighting nausea or vomiting. As an additional complication, the symptoms of pleural mesothelioma can also make swallowing food more difficult.
It is important to stay hydrated and eat small portions of easily digestible foods. You can treat nausea with prescription medications, including palonosetron (Biloxi), aprepitant (Emend), and ondansetron (Zofran).

Sore in the mouth

Chemotherapy drugs can damage the cells in the mouth and lead to tooth and gum problems. Patients may also experience painful mouth sores if dental hygiene is poor prior to treatment.
Seeing a dentist a month before starting treatment can prevent wounds. Teeth cleaning is a start, but the dentist can also take x-rays to identify potential problems and give tips on self-care for gums and mouth ulcers.

Diarrhea and constipation

Chemotherapeutics often irritate the gastrointestinal mucosa and cause diarrhea and constipation. Patients with peritoneal mesothelioma may be more prone to these side effects due to cancer-related damage and regular irritation of that part of the body.

You can treat these symptoms with antidiarrheal drugs or laxatives that are available in most drugstores. Simple changes, eg. For example, drinking more water and eating more fruits and vegetables can also help alleviate these side effects.

Hair loss

Hair loss is perhaps the most common side effect of chemotherapy. Unfortunately, unlike the others, it is not treatable. Since hair is one of the fastest dividing healthy cells in our body. It is very prone to damage from chemotherapy. Some patients wear wigs, and some insurance plans help cover the cost of buying wigs.

Chemo Brain

Chemo brain can include forgetfulness, misty thoughts, and other forms of cognitive impairment. Many chemo-patients suffer from varying degrees of cognitive impairment from mild to severe. Chemo brain is short-lived in some patients, while others show chemo-brain symptoms for months or years. Coping tips and strategies help patients cope with these symptoms.

Low blood levels

Chemotherapeutics may trigger a drop in blood cell levels a few days after the first dose of treatment. A decline in white blood cells (neutropenia) weakens the immune system; Platelet waste (thrombocytopenia) reduces the coagulation ability of the blood, and red blood cell degeneration (anemia) leads to fatigue.

Rare and serious side effects

Certain side effects of chemotherapy are more serious and should be monitored carefully. These symptoms may indicate a negative reaction to medication or infection.
See a doctor immediately if you learn:
  • Bloody stool or urine
  • Fever higher than 100.5 F
  • Unexplained bruises
  • Shortness of breath
  • an Intense headache
Patients experiencing severe chemotherapy problems are kindly requested to report them to the US Food and Drug Administration (FDA). Patients can submit a report on the FDA website to help researchers better tailor future treatment.

The Hidden Side Effects of Mesothelioma Chemotherapy

Some physical side effects, such as hair loss and weight fluctuations. Can cause mesothelioma patients to struggle with self-esteem, leading to depression and other emotional side effects.
In fact, up to 25 percent of cancer patients say they feel depressed during and after treatment. Counselors, support groups, antidepressants, and meditation can help patients cope with these psychological effects of chemotherapy.

Another little-known side effect is the financial toxicity. Which refers to "problems a cancer patient has associated with the cost of treatment," said the National Cancer Institute. Studies have proven that cancer treatment is less effective when patients have difficulty paying for it. And medical professionals are paying more and more attention to it.

Many cancer patients need financial support during treatment, and mesothelioma patients are no exception. Do not hesitate to discuss problems with your doctors and their staff during chemotherapy.



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Mesothelioma Master: Mesothelioma Chemotherapy | Chemo Treatments & Options
Mesothelioma Chemotherapy | Chemo Treatments & Options
Chemotherapy for Mesothelioma Patients. Mesothelioma Chemotherapy is a versatile treatment option for pleural and peritoneal mesothelioma patients.
Mesothelioma Master
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