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Chemotherapy Treatment and Available Drug Therapies for Malignant Pleural Mesothelioma
Chemotherapy can technically refer to the use of any medicine to treat a condition, but it most often is used to refer to the treatment of various cancers using powerful drugs. These drugs aim to prevent the growth, division, and spread of cancer cells. In some cases, chemotherapy drugs can trigger the death of cancer cells directly.[1]
Because it can be extremely difficult to target cancer cells without targeting healthy ones, chemotherapy can lead to a broad range of side effects. These side effects can include: pain, mouth sores, diarrhea, nausea, constipation, blood disorders, hair loss, tingling or burning sensations, muscle weakness, loss of balance, trembling, fatigue, changes in memory or cognition, appetite loss, hair loss, and heart-related symptoms.[2]
However, the effectiveness of the drugs serves as an important measure in stemming the growth and metastasization of cancer cells.
Certain chemotherapy drugs can be used to target a mesothelioma patient’s specific condition while minimizing undesirable side effects. Patients can coordinate with their medical team to determine the optimal drugs to take in order to improve their prognosis while reducing the symptoms that can come from unrestrained cancer growth.[3]
Types of Chemotherapy
There are hundreds of different types of chemotherapy drugs, all of them used for different goals or to treat different types of cancer.
The main goals of chemotherapy include:
- Neoadjuvant chemotherapy: The use of chemo drugs to shrink a tumor before radiation, surgery, or both
- Adjuvant chemotherapy: The use of chemo drugs after surgery or radiation treatment to destroy any remaining cancer cells or control their growth and spread
Chemotherapy is often used along with other forms of cancer treatment in order to seek the optimal outcome for patients.
How Chemotherapy Is Administered
Administering chemotherapy can be performed through a number of methods. These include taking oral doses, using an IV, having injections directly into a body cavity, intra-arterial chemo, and even topicals. In some cases, an IV catheter is used, although a port may be surgically implanted or a pump may be used.[4]
An oncologist will determine the optimal dosage based on your body weight, your body surface area, blood test results, and other factors known about your health and the specific type of cancer you face. They will set a schedule for administering chemotherapy in intervals called cycles. Cycles include periods of rest to give your healthy cells time to recover in between treatments.[5]
Most Common Chemotherapy Drugs for Mesothelioma and Other Cancers
The most commonly recommended drugs for treating mesothelioma and other forms of cancer with chemotherapy include:
- Alimta
- Pemetrexed
- Cisplatin
- Carboplatin
- Navelbine
- Doxorubicin
- Raltitrexed
Chemotherapy Drugs Used to Treat Mesothelioma
Mesothelioma can respond well to treatment from a combination of chemotherapy and surgery.[6] Chemotherapy drugs can be administered intravenously (through an IV), but they can also be injected directly into the mesothelial site of cancer growth.
For malignant pleural mesothelioma, chemo drugs could be fed through a small chest tube directly into the pleural cavity. The drugs may also be heated to increase their efficacy, a strategy called hyperthermic chemotherapy or “hot chemo,” colloquially. Intrapleural chemotherapy drugs can be administered as a final step of surgery, a method referred to as “heated intraoperative chemotherapy.”[7]
Combinations of chemotherapy drugs have been demonstrated to have the maximum chance of producing a positive outcome among mesothelioma patients, especially among those for whom surgery is not a viable option.
According to medical literature, cisplatin and pemetrexed tend to produce the best results for mesothelioma patients as a form of first-line therapy.[8],[9] The combination of gemcitabine and cisplatin has also increased in use owing to the diminished toxicity profile and corresponding side effects.[10],[11]
Note that in most cases, unresectable malignant mesothelioma has a universally poor prognosis, so many chemotherapy treatments aim to control the spread of the cancer and improve survivability rather than seek a complete cure.[12]
Common chemotherapy drugs prescribed for malignant mesothelioma include the following, each of which are described in greater detail in the sections below:
Gemcitabine/Cisplatin Combination
A combination of the drugs gemcitabine and cisplatin can be used for effective treatment of malignant pleural mesothelioma, especially among patients who have non-resectable tumors.[13] The treatment is also used for other forms of advanced cancer thanks to its manageable toxicity profile and therapeutic benefits.[14]
However, at least one study notes that the use of cisplatin plus pemetrexed may offer better results in inoperable malignant mesothelioma patients who can tolerate the toxicity.[15]
Note that the combination of gemcitabine and cisplatin is only FDA-approved for treatment of non-resectable malignant pleural mesothelioma. Patients with potentially resectable tumors may be required to be admitted into a clinical trial in order to receive the combination treatment.[16]
The combination of gemcitabine and cisplatin can be used for a number of cancers, including:
- Bladder cancer
- Cervical cancer
- Ovarian cancer
- Biliary tract cancer
- Pancreatic cancer
- Malignant mesothelioma
- Non-small cell lung cancer
Other Chemotherapy Drugs Available for Malignant Mesothelioma Treatment
Different patient cases, preferences, and tolerance for the toxicity of chemotherapy drugs can encourage the use of chemotherapy regimen different from the drugs described above.
The drugs below may be given in combination with pemetrexed, cisplatin, or gemcitabine, or they may be combined with one another. They can also be administered as a single drug if there is concern over the patient’s tolerance.
Research on effective first-line and second-line treatment of malignant mesothelioma is still ongoing, meaning that many of the uses of the following drugs are technically unapproved and are still being actively explored in clinical trials.
Common chemotherapy drugs used to treat mesothelioma aside from pemetrexed, cisplatin, and gemcitabine include:
Each is described in detail below.
[1] https://medlineplus.gov/cancerchemotherapy.html
[2] https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/side-effects-chemotherapy
[3] https://my.clevelandclinic.org/health/treatments/16859-chemotherapy-for-cancer-treatments
[4] https://www.cancer.gov/about-cancer/treatment/types/chemotherapy
[5] https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/how-is-chemotherapy-used-to-treat-cancer.html
[6] https://www.cancer.org/cancer/malignant-mesothelioma/treating/chemotherapy.html
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999165/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741799/
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830568/
[10] https://link.springer.com/article/10.1007/s10330-013-1164-4
[11] https://www.ncbi.nlm.nih.gov/pubmed/15923792
[12] https://erj.ersjournals.com/content/40/1/185
[13] https://www.macmillan.org.uk/information-and-support/treating/chemotherapy/drugs-and-combination-regimens/combination-chemotherapy/gemcitabine-and-cisplatin-gemcis.html
[14] https://www.ncbi.nlm.nih.gov/pubmed/12714891
[15] https://www.ncbi.nlm.nih.gov/pubmed/24636265
[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503655/
