Chemotherapy and Mesothelioma

Chemotherapy is a term that describes the use of drugs to kill cancer cells. Chemotherapy is one of the most common and established treatments for cancer, including mesothelioma. In treating mesothelioma, chemotherapy is used to slow the progress of the disease and to reduce symptoms. It does not cure the disease, however.

There are several general types of chemotherapy. Neo-adjuvant therapy shrinks a tumor prior to surgery being performed, meaning that the surgery will be less involved or invasive. Adjuvant therapy focuses on killing cancer cells that remain after surgery is performed. Chemotherapy drugs can also be used to increase the impact of either radiation or immunotherapy. It can also be used to destroy cancer that comes back or that has spread (or metastasized) to other areas of the body.

After an initial diagnosis of mesothelioma is made, a physician will then “stage” the disease. The staging process describes the severity of the mesothelioma based on factors such as whether the cancer has spread from one side of the chest to the other, whether it has spread to lymph nodes, and whether it has metastasized to more distant parts of the body. Staging is an important part of the treatment process, because it helps determine the most appropriate type of treatment to use. In determining treatment recommendations, physicians will also consider issues such as the stage of the disease, a patient’s age, gender and general health, and a patient’s wishes. Depending on the stage of mesothelioma that an individual has, chemotherapy may be the primary form of treatment or, as discussed above, it may be used as an adjuvant treatment to increase the effects of other forms of radiation therapy and/or surgery.

Chemotherapy drugs work differently, but are all focused on the same goal: destroying cancer cells and keeping them from reproducing. The names of some of the most commonly used drugs are cisplatin, gemcitabine, coramsine, and endostatin. Drugs may be administered individually, or, in what is called combination therapy, in pairs. A new combination of drugs is raltitrexed and cisplatin. This combination has been shown to increase lifespan more than cisplatin does on its own. Other common pairings include:

These drugs are often very powerful and it is common for them to affect healthy cells in the body as well as cancerous ones. Specifically, they affect cells that grow quickly, including hair and cells that are found in the mouth, stomach and other parts of the digestive system. This is why hair loss is such a common side effect of chemotherapy. Other side effects include nausea and vomiting, loss of appetite and sores in the mouth. Chemotherapy can also impact the cells in the bone marrow which produce blood, leading to lowered blood cell counts. As a result, those undergoing chemotherapy treatment may be at risk for infection; increased bleeding or bruising; or shortness of breath and exhaustion. There are many things that can be done to help a patient feel more comfortable during chemotherapy treatment, including having palatable and soothing food available.

Most side effects end once the treatment is over, and there are medications that can be given to reduce the impact of side effects. Additionally, some people choose to use complementary therapies, such as acupuncture, massage and aromatherapy, to reduce chemotherapy side effects and general discomfort and pain associated with mesothelioma. For example, research has shown that acupuncture, which is a form of Eastern medicine, is effective in reducing nausea and vomiting. Those who pursue complementary therapies should inform their physician of this immediately to make sure that such treatments do not interfere in any ways with the effectiveness of chemotherapy drugs.

There are several ways to take chemotherapy drugs. Chemotherapy drugs can be administered intravenously (through an injection) or orally (with pills). The drug will travel through the entire body to reach and then attack the cancer cells.
In the case of mesothelioma, there are some additional ways to administer the drugs. The drugs can be administered intrapleurally (into the pleura, or chest cavity) or intraperitoneally (into the peritoneum, or abdominal cavity). (The pleura or peritoneum are the most common sites of mesothelioma.) The length of a course of chemotherapy can vary between days and weeks at a time. Patients can receive chemotherapy at a doctor’s office or at a hospital.

When new chemotherapy drugs are developed, they must be tested through clinical trials to determine their effectiveness and safety. Depending on the outcomes of the clinical trial, the drug will either be approved by the Federal Drug Administration and available for general use, or discontinued.

Some individuals may choose to participate in clinical trials in order to have access to the newest medications, or when established therapies have not been successful. An individual can work with his/her doctor to determine whether participation in a clinical trial is advisable. Resources such as the National Cancer Institute have information about current clinical trials, which can be accessed at this website: http://www.cancer.gov/clinicaltrials. At any given time, clinical trials may be being conducted across the nation, testing new drugs and new combinations of drugs. Two drugs that are currently being tested are paclitaxel and irinotecan (1).

Other established forms of treatment for mesothelioma include radiation therapy and surgery. There are also a number of experimental treatments, the effects of which are still being evaluated. As discussed, there is not yet a cure for this rare and aggressive form of cancer. According to the National Cancer Institute, “median survival has been reported as 16 months for patients with malignant pleural disease and 5 months for patients with extensive disease” (2). Treatment focuses on extending lifespan by slowing the growth of the disease, and on improving comfort and quality of life by reducing symptoms such as shortness of breath. Patients are encouraged to work closely with physicians to make informed decisions about the type of treatment that is best suited to their wishes.

'Chemotherapy and Mesothelioma' Resources:
  1. American Cancer Society. “Chemotherapy.” 19 October 2006.
    Accessed: 27 August 2007.
  2. National Cancer Institute. “Malignant Mesothelioma: General Information.” 22 June 2005.
    Accessed: 27 August 2007.