Chemotherapy for Mesothelioma

Chemotherapy (chemo) is treatment with anti-cancer drugs. For mesothelioma, chemo can be given through a vein or put right into the body space where the cancer is.

When is chemotherapy used for mesothelioma?

Chemo can be used in different ways to treat mesothelioma. It is often used along with radiation therapy.

• Chemo can be used as part of the main treatment for people who aren’t getting surgery.
• If mesothelioma might be treated with surgery, chemo might be given beforehand to try to shrink the cancer and lower the risk that it will spread. This is called neoadjuvant therapy.
• Chemo can be given after surgery to try to kill any cancer cells that were left behind. This type of treatment, called adjuvant therapy, might help delay or help keep the cancer from growing back.

Chemo might not be recommended for people in poor health. Chemo can often help shrink the cancer or slow its growth, but it's very unlikely that it will make it go away completely.

How is chemotherapy given to treat mesothelioma?

There are 2 main ways chemo can be given to treat mesothelioma.

Chemotherapy drugs used for mesothelioma

Different chemo drugs can be used to treat mesothelioma, including:

• Pemetrexed
• Cisplatin
• Carboplatin
• Gemcitabine
• Vinorelbine

Chemo is often given as a combination of 2 drugs. But single drugs can be used in people who might not be able to tolerate more than one drug. When 2 drugs are used, the most common combination is pemetrexed and either cisplatin or carboplatin. Other combinations might be used as well.

Pemetrexed lowers levels of folic acid and vitamin B12 in the body, so people getting pemetrexed need to get these vitamins as well to help avoid certain side effects.

Chemo drugs that might be used for HIPEC or PIPAC include:

• Cisplatin
• Carboplatin
• Mitomycin
• Doxorubicin

Sometimes a targeted therapy drug or an immunotherapy might be given as well.

Possible side effects of chemo

Chemo drugs attack cells in the body that are dividing quickly, which can lead to side effects. The side effects depend on the type and dose of drugs given, how they're given, and how long they're used. Intraperitoneal chemo tends to cause fewer problems than systemic chemo.

Common side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections from having too few white blood cells
• Easy bruising or bleeding from having too few blood platelets
• Fatigue from having too few red blood cells

Some drugs can have other side effects. For example, cisplatin and carboplatin can cause peripheral neuropathy (nerve damage). This can sometimes lead to:

• Hearing loss
• Pain, burning, or tingling sensations in the hands and feet
• Sensitivity to cold or heat
• Weakness

These side effects usually go away after treatment is finished, but some can last a long time in some people. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Be sure to ask your cancer care team about what to expect and to report any side effects or changes you notice so that you can get them treated right away. The doses of the drugs might need to be lowered or treatment might need to be delayed or stopped to keep the side effects from getting worse.