Chemotherapy is treatment with anti-cancer drugs. There are 2 main ways that chemotherapy can be given to treat mesothelioma.

In systemic therapy, chemotherapy is swallowed in pill form or injected into a vein. The drug enters the bloodstream and circulates throughout the body to reach and destroy the cancer cells wherever they may be.

Chemotherapy drugs may also be given intrapleurally (directly into the chest cavity) or intraperitoneally (into the abdominal cavity) through a small incision in the chest or abdominal wall. This approach may allow doctors to give higher doses of chemotherapy to the tumor while limiting the side effects to the rest of the body. Chemotherapy drugs given this way may be heated first (hyperthermic chemotherapy), which may help them work better.

For mesotheliomas that can be treated with surgery, chemotherapy may be given before (neoadjuvant) and/or after (adjuvant) surgery to try to improve the outcome. For cancers that are not resectable, chemotherapy may be the main treatment (alone or along with radiation therapy). Chemotherapy may slow the progression of the disease, but it is very unlikely to make it go away completely.

Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.

Several chemotherapy drugs have been used to treat mesothelioma. Most doctors now use a combination of the drugs pemetrexed (Alimta) and cisplatin. Pemetrexed interferes with levels of folic acid and vitamin B12 in the body, so these must also be given to avoid certain side effects.

Other chemotherapy drugs used to treat mesothelioma include:

• gemcitabine
• carboplatin
• methotrexate
• vincristine
• vinblastine
• mitomycin
• doxorubicin
• epirubicin
• cyclophosphamide
• ifosfamide

These drugs are usually given in combinations of 2 or more, but single drugs can be used in people who may not be able to tolerate combinations of drugs. Several other drugs are also being studied to determine their effectiveness in treating mesothelioma.

Possible side effects

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs you are given and on how long they are used for. These side effects can include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

Some drugs can have other side effects. For example, cisplatin can damage nerves. This can sometimes lead to hearing loss or symptoms in the hands and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. (This is called peripheral neuropathy.) In most cases this goes away once treatment is stopped, but it may last a long time in some people. You should report this, as well as any other side effects or changes you notice while getting chemotherapy, to your medical team so that you can get prompt treatment for them. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

For more general information about chemotherapy, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.

Last Medical Review: 03/17/2009
Last Revised: 03/17/2009