Mesothelioma Chemotherapy

Most mesothelioma patients undergo chemotherapy either as a standalone treatment or as part of a multimodal approach. Certain chemotherapy treatments have shown promising survival results. Doctors continue to study how chemotherapy can be used to help mesothelioma patients.

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Chemotherapy Treatment for Mesothelioma

During chemotherapy, patients receive potent drugs that destroy cancer cells. To treat mesothelioma, these drugs may be given intravenously (through a vein), in pill form, or directly into the abdominal or chest cavities during surgery.

Video Summary: Registered Nurse Amy Fair discusses what to expect when getting mesothelioma chemotherapy and its side effects. View Transcript.

What do I need to know about radiation and chemotherapy?

If radiation chemotherapy is the treatment choice your oncologist will talk with you about the side effects of radiation and the side effects of chemotherapy. They will talk with you about the different blood tests that need to be done. They usually check your B9 and your B12. They will check your platelet counts, blood counts that tend to fall during treatment such as chemotherapy.

The role of chemotherapy is to prevent those cancer cells from replicating. It not only kills the bad cells but it kills the good cells too. You’ll see nausea and some hair loss. So with the toxicity of chemotherapy do come some side effects. There are many medications out there now that control nausea. There are many medications out there that can help stimulate your appetite during chemotherapy. It’s important to keep a good relationship with your oncologist and be knowledgeable going into the therapy about the possible side effects.

Mesothelioma chemotherapy (chemo) may be administered in two primary ways. Learn more about each below.

  • Systemic Chemotherapy

    In this procedure, chemotherapy drugs are most commonly administered to the patient through a port or needle into a vein. The drug then enters the bloodstream, destroying cancer cells wherever they are in the body.

  • Intraoperative Chemotherapy

    Mesothelioma doctors execute this treatment after performing surgery while the incision site is still open. The heated anti-cancer drug is released directly into the chest or abdominal cavity after the surgeon has removed all visible cancer. The chemotherapy then kills any remaining microscopic cancer cells that can’t be seen by the surgeon.

There are several different kinds of chemotherapy drugs for mesothelioma, including cisplatin, pemetrexed, and gemcitabine.

While some people do not respond well to these drugs, many mesothelioma patients have been able to beat the odds and live longer with the help of chemotherapy treatment.

Quick Facts About Mesothelioma Chemotherapy

  • Chemotherapy treatment for pleural mesothelioma can reduce tumors in 40% of patients.
  • Administering two chemotherapy drugs rather than just one results in longer survival rates.
  • Chemotherapy after surgery results in improved survival rates.
  • Chemotherapy is given in cycles that last 2-3 weeks with a rest period in between.

Benefits of Chemotherapy for Mesothelioma

Mesothelioma doctors still disagree about the effectiveness of chemotherapy for mesothelioma. However, some patients have responded well to chemotherapy treatment.

Chemotherapy may be offered to patients as a treatment option at any of the four stages of mesothelioma. However, specific mesothelioma treatment goals vary depending on the patient’s condition.

Doctors use chemotherapy for mesothelioma to:

  • Kill remaining cancer cells left over after surgery
  • Prevent recurrence (when the mesothelioma comes back) by administering chemotherapy directly into the body
  • Reduce painful symptoms by destroying cancer cells, which may shrink tumors
  • Shrink tumors and eliminate mesothelioma cells before surgery to help improve surgical success

Mesothelioma specialists are continuing to study different chemotherapy techniques to get the best results for patients seeking both curative (life-extending) and palliative (symptom-reducing) treatments.

Mesothelioma Prognosis After Chemotherapy

Chemotherapy improves the overall prognosis of most mesothelioma patients — both by itself and when combined with other treatments like surgery.

Because mesothelioma is often not discovered until it has already spread (stage 3 or stage 4 mesothelioma), only 20% of patients are candidates for curative surgery.

Survival Rates with Chemotherapy Alone
The standard treatment for the remaining 80% is chemotherapy by itself with a median survival rate of 12 months.

For patients whose mesothelioma is caught in the earlier stages and are able to undergo surgery, they often receive a multimodal approach to treatment.

This involves surgery, radiation, and chemotherapy. Their median survival rate is between 12-29 months depending on which surgical procedure they receive.

For patients with late-stage mesothelioma that cannot be removed through surgery, chemotherapy may also help slow cancer growth and ease symptoms.

Types of Chemotherapy Drugs for Mesothelioma

Mesothelioma chemotherapy drugs are highly concentrated, anti-cancer medications.

When these drugs are injected into the bloodstream, they circulate through the body and destroy mesothelioma cells in their path. This slows the rate of cancer growth.

Did You Know?

Several chemotherapy drugs can treat mesothelioma. Doctors prescribe certain drugs — or combinations of drugs — based on the desired treatment outcomes.

Mesothelioma researchers have found that combining two drugs is more effective than using a single drug.

Cisplatin and Pemetrexed

The combination of cisplatin and pemetrexed (Alimta®) has been the standard therapy for mesothelioma patients for over 10 years.

This combination is currently the only FDA-approved drug combination for mesothelioma.

These are typically the first drugs that mesothelioma patients receive. When patients cannot tolerate cisplatin, it can be replaced with carboplatin — another platinum-based chemotherapy drug.

Cisplatin and pemetrexed can significantly improve mesothelioma survival rates.

Mesothelioma patients typically continue receiving this combination of drugs until they stop responding to them or develop too many side effects.


Gemcitabine (Gemzar®) is a chemotherapy drug initially developed for breast and lung cancers. However, it’s been found effective for improving life expectancy in late-stage mesothelioma patients.

When the first-line chemotherapy solution of cisplatin and pemetrexed stops working, gemcitabine can be prescribed as a second-line treatment.

Other Mesothelioma Chemotherapy Drugs

There are several other chemotherapy medications for mesothelioma that patients can be prescribed.

Other mesothelioma chemotherapy drugs may include:

  • Navelbine (vinorelbine)
  • Doxorubicin (Adriamycin®)
  • Carboplatin (Paraplatin®)

Patients can learn more about affording chemotherapy and other treatment options by speaking with a legal professional.

Multimodal Treatment and Chemotherapy

A multimodal (more than one) treatment plan involves using more than one form of mesothelioma treatment (generally surgery, chemotherapy, and/or radiation) in order to increase a patient’s chances of long-term survival.

The best chemotherapy results are seen when it is combined with surgery, and some patients have experienced long periods of remission following this treatment.

Multimodal Survival Rates
A multimodal treatment approach that involves chemotherapy, surgery, and radiation therapy may increase survival to over 5 years in some patients.

Mesothelioma doctors may use chemotherapy in different ways to achieve the best results for multimodal therapy.

As part of a multimodal treatment plan, chemotherapy may be used in several ways. Learn more about each below.

  • Neoadjuvant Therapy

    Chemotherapy may be used before surgery to shrink the cancer and make it operable and easier to remove or to prevent cancer from spreading during the operation. This is called neoadjuvant chemotherapy.

  • Intraoperative Chemotherapy

    During intraoperative chemotherapy, chemotherapy drugs are delivered directly to the location of the tumor after as much cancer as possible has been surgically removed.

  • Adjuvant Therapy

    Chemotherapy may also be used after surgery to prevent cancer from growing back. This is called adjuvant chemotherapy.

A combination of chemotherapy and radiation therapy may also be useful for controlling cancer symptoms when surgery is not a realistic option.

New Chemotherapy Treatments

Mesothelioma specialists conduct ongoing research to develop new mesothelioma chemotherapy drugs that extend the lives and wellbeing of those afflicted with this deadly disease.

Researchers offer clinical trials to mesothelioma cancer victims to improve their understanding of a certain treatment and hopefully give patients better results than they are currently receiving through standard treatment.

Targeted Chemotherapy for Mesothelioma

The medical community uses targeted chemotherapy for many types of cancer, and this treatment is receiving attention among mesothelioma specialists.

Targeted chemotherapy is a newer kind of “smart” therapy that targets changes in cells that are unique to cancer. This way, targeted therapy is able to destroy cancer cells without affecting healthy cells and producing symptoms.

This type of chemotherapy impacts all of the body’s fast-growing cells, such as hair follicles and blood-forming cells.

Did You Know?

By sparing healthy cells, targeted therapy can reduce common chemotherapy symptoms like hair loss, nausea, diarrhea, and anemia.

Doctors may also be able to apply heavier doses of chemotherapy, killing more cancer in the process.

Researchers have discovered gene and protein changes when mesothelioma presents itself in a person. Targeted chemo drugs work to directly address the changes caused by the disease.

A protein called VEGF (vascular endothelial growth factor) aids cancerous tumors by forming new blood vessels so they can access the nutrients they need to continue growing.

A newer drug called Bevacizumab (Avastin®) stops VEGF from working and thus helps starve the tumor.

When given alongside the chemotherapy drugs pemetrexed and cisplatin, it has been shown to help people with mesothelioma live longer.

Mesothelioma Chemotherapy Clinical Trials

Specialists often recommend that their patients join mesothelioma clinical trials where new drugs and treatments are constantly being developed and tested.

Doctors hope to improve the quality and lifespan of mesothelioma patients through these clinical trials.

Ongoing Clinical Trials
The National Cancer Institute supports 55 ongoing clinical trials designed to continue the fight to extend the lives of those afflicted with mesothelioma and one day find a cure. The Mesothelioma Applied Research Foundation lists 71 trials.

Trials are usually conducted in three phases and will only proceed to the next phase if there has been success in the prior phase.

Clinical trial phases are as follows:

  • Phase I: The first phase includes only a small group of participants and determines the best-tolerated drug dose, how the drug or other treatment should be administered, and how it affects the human body.
  • Phase II: The second phase uses a larger but still limited number of participants and aims to determine response rates and other parameters of treatment success.
  • Phase III: The third phase is often jointly performed by multiple institutions, enrolls many more patients, and aims to determine success fo a particular treatment as opposed to an older, more accepted treatment, or placebo. Phase III studies are often randomized, meaning that there are two or more “arms,” each treated differently and eventually compared. An arm can also contain a placebo. Patients are randomized to one of the arms. Double-blinded means that neither the patient nor the treating physician knows what treatment is being given on each particular arm.

In some trials, researchers combine phases for a more seamless transition, such as phase II that transitions into a phase III after enough patients had been enrolled, allowing research questions to be answered more quickly with fewer patients.

Chemotherapy by Mesothelioma Type

Pleural mesothelioma is the most common form of the disease, resulting from asbestos exposure that affects the lining of the pleural cavity where the lungs rest.

Did You Know?

According to the American Cancer Society, 81% of new cases fall into this category. Other types of mesothelioma may form in the linings of the abdomen, heart, or testicles.

Standard chemotherapy treatment is similar for all types of mesothelioma.

Chemotherapy for Pleural Mesothelioma

Chemotherapy is commonly used to treat patients with pleural mesothelioma either alone or in combination with surgery and/or radiation therapy. Pleural mesothelioma chemotherapy may be palliative or curative.

Since 2004, doctors have used a combination of the drugs pemetrexed and cisplatin for the treatment of malignant pleural mesothelioma. This drug combination helps cancer patients by slowing the progression of the disease and improving quality of life.

Pleural mesothelioma chemotherapy takes two major forms:

  • Intraoperative chemotherapy: For surgical patients who receive either an extrapleural pneumonectomy (removal of the diseased lung and surrounding tissue and tumors) or pleural decortication (P/D) (removal of the diseased lining of the lung), the more localized form of chemotherapy called HITHOC has been proven to increase the length of survival.
  • Systemic chemotherapy: Research shows that this systematic chemotherapy reduces tumors in 40% of patients, therefore extending the life of the receiver. Because chemotherapy can shrink tumors, it may help patients who are struggling to breathe and have fluid buildup in their lungs.

HITHOC (Hypothermic Intrathoracic Chemotherapy) is a procedure where heated chemotherapy drugs are applied directly into the pleural cavity directly after the surgeon removes all visible cancerous tumors and tissue.

The drug kills the remaining microscopic cancer cells, and the heat allows the drug to better permeate the tissue and magnifies the kill. Cisplatin is most often used in HITHOC, but also doxorubicin and mitomycin C can be used.

Chemotherapy for Peritoneal Mesothelioma

Specialists also use the combination of pemetrexed and cisplatin to treat patients with peritoneal mesothelioma.

As for pleural mesothelioma, peritoneal mesothelioma chemotherapy comes in two major forms.

Types of peritoneal mesothelioma chemotherapy include:

  • Systemic chemotherapy: Administered systemically, it is the first line of defense for patients who have been diagnosed in the later stages of mesothelioma. Carboplatin can be successfully substituted for cisplatin and seems to be better tolerated by patients receiving the treatment.
  • Intraoperative chemotherapy: For surgical candidates whose mesothelioma has been diagnosed in the earlier stages, the chemotherapy treatment called HIPEC (hyperthermic intraperitoneal chemotherapy) offers promise to extend life.

Similar to HITHOC in the chest cavity, the heated chemotherapy drug is administered locally in the stomach cavity immediately after surgical removal of visible cancerous tumors and tissue.

HITHOC kills the cancer cells left behind that are invisible to the naked eye.

Survival rates for malignant peritoneal mesothelioma patients who are surgical candidates can range from 38-92 months after the surgical/chemotherapy treatment combination.

Chemotherapy for Pericardial Mesothelioma

Pericardial mesothelioma (a cancer of the lining of the heart) is so rare that research and study on treatments lag behind those of more frequent cancers.

It is often misdiagnosed or found in the late stages with a very poor prognosis. Most cases of pericardial mesothelioma are discovered after the victim has already died.

However, the combination of pemetrexed and cisplatin has been shown to offer some benefits to slightly lengthen life for those who receive this systematic chemotherapy.

Chemotherapy for Testicular Mesothelioma

Testicular mesothelioma is the rarest form of mesothelioma, making up less than 1% of all mesothelioma cases.

Adjuvant mesothelioma chemotherapy and radiotherapy have not been clearly shown to be most effective for this type since the number of cases is so few.

However, testicular mesothelioma has a relatively high survival rate. 47% of its victims are still alive 2 years after diagnosis.

Surgical removal of the tumor can eradicate the cancer if discovered in its early stages. This is sometimes followed up with radiation and chemotherapy using pemetrexed and cisplatin.

What to Expect During Mesothelioma Chemotherapy

If your doctor has recommended chemotherapy for your mesothelioma, consult a specialist before beginning treatment.

Medical oncologists (cancer doctors) who are also mesothelioma experts will have dedicated their careers to researching the best possible chemotherapy drug combinations for each type of mesothelioma.

Your mesothelioma doctor will work with you to come up with a treatment plan and explain what you can expect during chemotherapy for mesothelioma.

Systemic Chemotherapy Process for Mesothelioma

A mesothelioma chemotherapy regimen involves a series of treatment cycles that take place over a set period of time. Patients may receive a single drug or a combination of drugs during each treatment.

Specialists develop personalized mesothelioma chemotherapy treatment plans for each patient based on their individual medical needs and goals.

Your treatment regimen will outline the particular chemotherapy drugs, dosages, and methods of administration to be used during your treatment.

Chemotherapy for mesothelioma generally involves the following steps:

  1. Chemotherapy is most often given as an infusion into a vein through a needle inserted in the skin. The drugs can also be given by inserting a tube into a device in a vein in your chest.
  2. Doctors administer mesothelioma chemotherapy in cycles of 3-4 weeks each with a rest period in between. This gives healthy cells time to recover between the treatments.
  3. A single chemotherapy session might last anywhere from a few minutes to hours depending on the specific treatment prescribed by your doctor.

Most patients receive 4-6 cycles of chemotherapy treatment depending on the state of the mesothelioma and the response to the drugs. Effectiveness should be reassessed every 2-3 cycles.

If mesothelioma chemotherapy is proving effective the treatment might continue longer.

Intraoperative Chemotherapy Process for Mesothelioma

Intraoperative chemotherapy takes place in the operating room following mesothelioma surgery.

After opening up the chest or abdominal cavity, the surgeon removes all visible tumors and then administers chemotherapy drugs to the affected area to eradicate any microscopic cancer cells that are left behind.

Did You Know?

Hyperthermic (or heated) intraoperative peritoneal chemotherapy (HIPEC) is the name of the procedure used for peritoneal mesothelioma patients who receive chemotherapy in the abdominal cavity.

After surgically removing visible tumors, the surgeon continuously circulates a heated sterile solution containing a chemotherapy drug throughout the peritoneal cavity for up to 2 hours.

The serum is heated to promote better absorption into the tissue, helping the chemotherapy eliminate any remaining cancer cells.

Hyperthermic intrathoracic chemotherapy (HITHOC) is a similar procedure but designed for the thoracic cavity during pleural mesothelioma surgery.

HITHOC takes place after the thoracic surgeon removes the lung and surrounding tissue through an extrapleural pneumonectomy or removes just the diseased lining of the lung (pleural decortication).

With the chest cavity still open, a heated chemotherapy solution bathes the inside of the pleural area to kill any tiny tumors or cancer cells that may have remained.

How to Prepare for Chemotherapy

Chemotherapy involves introducing potent drugs in your body so they can effectively kill deadly cancer cells.

Because the drugs are so strong, patients are encouraged to prepare their body for the drugs’ introduction in order to receive the most benefit from the treatment.

A  doctor will determine how mesothelioma chemotherapy should be administered.

To prepare for mesothelioma chemotherapy, patients may need to do the following.

  • Get a Chemotherapy Access

    Patients receiving intravenous chemotherapy may have a port, catheter, or pump surgically implanted to deliver the chemotherapy.

  • Testing

    Patients take blood tests to make sure they are strong enough to receive chemotherapy drugs. Tests might be conducted on the blood, liver, kidneys, and heart to make sure they are functioning properly.

  • Visit the Dentist

    Patients may need to see a dentist to make sure there are no infections in the mouth. During chemotherapy, it is more difficult for the body to fight off infection.

  • Plan Ahead for Side Effects

    Patients concerned about fertility issues should preserve eggs or sperm for future use. They may wish to prepare a head covering in the case of hair loss and ask their doctor about anti-nausea and vomiting drugs.

  • Arrange Extra Help

    Often, people who are undergoing chemotherapy treatment continue to work and perform activities. Patients should ask their doctor what to expect and ask if you will need to arrange for extra help at home in the event your side effects prevent you from carrying out normal activities.

  • Prepare for the First Treatment

    Patients should prepare for their first treatment by arriving well-rested. They may wish to eat a light meal beforehand in case the chemotherapy makes them nauseous, and they may be lightly sedated. While most people drive themselves back and forth to treatment, the first time someone else should drive until the patient and their doctor can see how they react to the drugs.

The best way to prepare for chemotherapy will vary among individuals. Patients should always follow the professional medical advice of their doctor.

Side Effects of Chemotherapy

Chemotherapy is well-known for its noticeable and difficult side effects. Mesothelioma chemotherapy drugs are effective against cancer because they attack fast-growing cells.

However, these drugs also target healthy cells that grow quickly, like cells of the hair, digestive tract, mouth, and reproductive system. Many of chemotherapy’s side effects result from the death of these cells.

Some of the most common chemotherapy side effects include:

  • Hair loss
  • Fatigue
  • Nausea
  • Loss of appetite
  • Mouth sores
  • Weakened immune system
  • Weight changes
  • Constipation and diarrhea

Mesothelioma chemotherapy drugs affect patients differently. Some patients experience severe side effects and need to stop or change drugs.

If this happens, a mesothelioma patient’s health care team will do everything they can to keep them comfortable.

Did You Know?

A common practice during mesothelioma chemotherapy with Alimta is for doctors to prescribe folic acid and B12 supplements. Supplementing with these two vitamins can help curb the common side effects of chemotherapy.

However, some vitamins can make mesothelioma chemotherapy less effective.

Patients undergoing mesothelioma chemotherapy therapy should be sure to talk to their cancer care team about how to best handle their side effects.

Learn More About Chemotherapy for Mesothelioma

For more information about receiving mesothelioma chemotherapy or getting in touch with a specialist for a consultation, contact the Mesothelioma Justice Network today.

Our Justice Support Team can answer any questions you have about chemotherapy for mesothelioma and how it works with your treatment plan.

Download our free mesothelioma guide today.

Mesothelioma Support Team
Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has nearly 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

Beth SwantekWritten by:

Contributing Author at the Mesothelioma Justice Center

Beth Swantek has been writing about the dangers of asbestos since 2013. Beth served as a media professional for over 30 years and began her career as a broadcast journalist. After her daughter suffered a traumatic brain injury at birth, Beth has devoted her life to helping men and women experiencing deep loss — such as those living with mesothelioma.

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