Chemotherapy for Mesothelioma

Chemotherapy is one of the most common and effective treatments for mesothelioma and over 80% of all cancer patients undergo chemo at some point. It is considered a first-line mesothelioma treatment, and can reduce tumors in around 40% of mesothelioma patients.

It can be daunting for mesothelioma patients to be told that they need chemotherapy. After a mesothelioma diagnosis patients find it empowering and comforting to inform themselves about the treatment, so they can know exactly how it works and how it is helping to fight their cancer.

In this article, we will explain the important points about chemotherapy and how it is used to treat mesothelioma. You can use this knowledge to prepare yourself for your chemotherapy treatments.

What is Chemotherapy?

Chemotherapy (or “chemo”) is a class of powerful cytotoxic (cancer-fighting) drugs that damage and kill rapidly multiplying cells, like the cancer cells that make up tumors. They are used to slow or stop tumor growth and the spread of cancer throughout the body (metastasis).

Since chemotherapy drugs target any quickly multiplying cells, they may damage healthy cells as well as cancer cells, often causing side effects. However, overall, chemotherapy can extend survival and improve quality of life for many cancer patients.

How is Chemotherapy Used to Treat Mesothelioma?

Chemotherapy can help mesothelioma patients in several important ways, most of which involve shrinking tumors and stopping tumor growth. This can be used therapeutically (to improve prognosis and lifespan), or as part of palliative care (to manage mesothelioma symptoms, especially pressure and pain from tumors, and improve quality of life).

Chemotherapy can be used at several different points in mesothelioma treatment. It may be used as a first-line treatment, the main treatment used to treat a mesothelioma patient, or a second-line treatment, which is used if a first-line treatment stops working. It can also be used as:

Neoadjuvant therapy, used before a first-line cancer treatment (e.g., using chemotherapy to shrink a tumor before surgery or radiation)
Intra-operative treatment, infused directly into the affected area immediately after tumor-removal surgery to kill off any remaining cells (e.g., HIPEC)
Adjuvant therapy, used after a first-line treatment to sustain beneficial effects (e.g., maintenance chemotherapy after surgery or radiation to prevent mesothelioma cells from growing back).

Often, chemotherapy is used as part of a multi-modal mesothelioma treatment, as one of several treatments used together. It may be used alongside treatments like radiation, surgery, immunotherapy, photodynamic therapy, and TTFields, among others. Using chemotherapy with other forms of treatment can make those treatments more effective, and vice versa.

Does Chemotherapy Cure Mesothelioma?

No, chemotherapy is not a cure for mesothelioma.

Chemo is typically an effective way to treat mesothelioma by:

Shrinking tumors
Slowing cancer growth
Relieve symptoms associated with mesothelioma

Results of chemotherapy are typically more effective when combined with other forms of treatment.

According to a study published in the British Journal of Cancer, newer combinations have shown tumor shrinkage in up to 45% of patients (compared to just 10 to 30% with older chemo drugs).

Read more about mesothelioma survival rates here.

What Types of Chemotherapy Drugs Are Used for Mesothelioma Patients?

A number of different chemotherapy drugs are used to treat mesothelioma, each of which has their own unique properties. Mesothelioma treatment often utilizes several types of chemo drugs, which can be more effective than using a single drug.

Your mesothelioma care team will decide which chemotherapy drugs are right for you based on factors like:

Your mesothelioma type and staging
Your age and overall health
Your allergies
Previous treatments you may have received, and their effectiveness
Potential side effects, treatment goals, and your quality of life

The most common chemotherapy drugs used for mesothelioma are cisplatin and pemetrexed (Alimta or Pemfexy). This combination is considered the first-line chemotherapy treatment for mesothelioma. Due to cisplatin’s harsh side effects, some patients may receive carboplatin instead, which is a similar drug with less severe side effects.

Other types of chemo drugs used for mesothelioma treatment include:

Cyclophosphamide (Cytoxan), which is sometimes used to support other chemotherapies.
Doxorubicin (Adriamycin) and mitomycin C, which are often used during cytoreductive HIPEC surgery for peritoneal mesothelioma
Gemcitabine (Gemzar), which can improve life expectancy in some late-stage mesothelioma patients.
Vinorelbine (Navelbine) and Paclitaxel, “antimicrotubule agents” that attack cancer cell proteins and are often used alongside cisplatin.
Oxaliplatin (Eloxatin) and Irinotecan, which interferes with cancer cell DNA replication and can slow mesothelioma cell growth in some cases.
Epirubicin, which can be used in some cases as a second-line palliative care treatment.

How is chemotherapy administered?

There are several ways to administer chemotherapy, depending on a patient’s needs.

Systemic Chemotherapy

Most patients receive systemic chemotherapy, which is administered multiple times on a set schedule (referred to as a “course” of treatment). It is most commonly delivered through intravenous (IV) infusion, wherein the drug is delivered into the bloodstream, usually over several hours.

Systemic IV infusions may be delivered through:

Needles: Inserted into a vein in the hand or lower arm and removed the same day after the infusion session.
Intra-Arterial (IA) Catheters: Thin tubes inserted into an artery or large vein that is feeding the cancer, usually in the chest. Catheters generally remain in place until the multiple-session treatment cycle is completed.
Ports: Small discs surgically implanted under the skin that are linked to a catheter, usually in the chest. Needles may be inserted into the port to administer chemotherapy or draw blood.
Pumps: Machines attached to ports or catheters that disperse a controlled amount of chemotherapy drugs into the body at timed intervals.

Some chemotherapy drugs, such as certain forms of pemetrexed, can also be delivered via injection, which takes less time than infusion. Others may be administered to mesothelioma patients via capsule or pill.

Local Chemotherapy

The other major type of chemotherapy for mesothelioma is local chemotherapy, which is delivered directly to the affected area rather than going through the bloodstream. This can be more effective for certain types of mesothelioma and can have fewer side effects for some patients.

The main type of local chemotherapy used for mesothelioma is Heated Intraoperative Chemotherapy (HIOC), in which heated liquid chemotherapy is administered directly into the abdomen or chest cavity, immediately after tumor removal surgery (cytoreductive surgery, or CRS).

After surgeons remove as much of the tumor and affected tissue as possible, the area is rinsed with heated chemo drugs, often with a specialized pump, to kill any remaining cancer cells. A drain is also installed to help remove the fluid after treatment.

The most common forms of HIOC are:

Hypothermic Intraperitoneal Chemotherapy (HIPEC), a first-line treatment for peritoneal mesothelioma.
Hypothermic Intrathoracic Chemotherapy (HITHOC), most often used to treat pleural mesothelioma.

How Often Will I Have to Go to Chemotherapy?

Most chemotherapy treatments are given in repeating cycles of 3 to 6 weeks, each consisting of several infusions, with rest periods in between.

On pemetrexed and cisplatin, the most common chemotherapy combination for mesothelioma patients, infusions are given every 21 days.

After around two cycles, your mesothelioma care team will evaluate how the drug is working. If it is working, they may continue your regimen; if it isn’t working, or if there are intolerable side effects, they may adjust dosages, or switch to another drug.

How to Prepare For Chemotherapy

Arrange caregiving assistance. During chemotherapy, you may need assistance with activities of daily living. Try to make arrangements in advance by asking friends or family members to help with specific tasks or care needs. You can always adjust your requests as your needs become clearer.
Get a dental checkup. Before you start chemotherapy, try to schedule an appointment with a chemotherapy-experienced dentist. They may be able to identify and address infections or other issues, reducing the risk of oral and dental side effects.
Take care of your body and mind. Take steps to reduce physical and mental stress in the days before and after your chemotherapy sessions. Focus on eating nutritious meals, drinking plenty of water, and getting a full night’s sleep.
Chemo-proof your home. Chemotherapy side effects often put mesothelioma patients at increased risk of injuring themselves. It may help to go through your house and eliminate physical risks (e.g., covering or blunting sharp corners and removing slipping hazards).
Plan for side effects and take advantage of palliative care: While you won’t know your side effects for sure until you experience them, it’s often helpful to plan for the most common effects in advance.
Prepare or arrange for meals in advance. During chemotherapy, mesothelioma patients often lack the energy to prepare meals for themselves. Many find it helpful to prepare or arrange for meal delivery in advance to make eating as easy as possible.
Stay away from people who are sick or may be sick. Remember that you will be very immunocompromised during chemo and should therefore avoid interaction with anyone who is sick or may be sick. You may want to cancel plans that involve large crowds, especially during COVID-19 surges and cold/flu seasons.

What are the main steps of the chemotherapy process?

Generally speaking, there are three main steps associated with the chemotherapy process for mesothelioma treatment:

Step 1 – Consultation

The chemotherapy process starts with a meeting with your mesothelioma care team to discuss your chemotherapy regimen and how it fits in with your treatment goals. This is your time to address any questions and concerns, and many patients find it helpful to make a list beforehand.

It may also be helpful to bring a trusted companion to help you advocate for yourself and record important information.

During your consultation, your care team may also conduct preliminary testing or imaging. They may also install a catheter (a tube inserted into a major artery that remains in place for the duration of your chemotherapy), or a port (a round metal or plastic disk inserted under the skin). Catheters and ports make repeated chemotherapy sessions quicker, easier, and less painful to administer.

Step 2 – Infusions

Your chemotherapy will likely consist of several infusions, in which chemotherapy drugs are delivered into your body through an IV (or through your catheter or port). Chemotherapy infusions are generally given in hospitals, cancer centers, or other outpatient treatment centers, and do not require inpatient care. Infusions range in length, but most take several hours.

You may want to bring a companion with you to your first chemotherapy session. In addition to emotional support, they can also make sure you get home safe.

When you first come for your infusion, you may have a brief wait, as chemotherapy drugs are generally prepared to order for each patient. When your infusion is ready, a nurse will help you get settled and place all necessary lines. They may give you fluids or other premedication to help with side effects.

During infusions, you will usually be seated in a comfortable chair, attached to an IV bag of medicine which will be delivered into your body over several hours. You may want to bring your computer, phone, tablet, books, or craft projects with you to pass the time, as well as pillows and blankets in case you’d like to nap.

Step 3 – Post-Infusion

Once the infusion is complete, you may be kept briefly to monitor for serious adverse reactions. After treatment, make sure to get lots of rest, drink plenty of fluids, avoid people who may be sick, and eat nutritious meals if possible.

Side effects may occur immediately or in the following weeks or months. It is often helpful to write down your side effects as they occur.

Common Chemotherapy Side Effects (and What You Can Do About them)

Chemotherapy has a large range of side effects which vary from patient to patient. Chemo works against mesothelioma by targeting rapidly multiplying cells, as are found in mesothelioma tumors.

However, the process may also damage healthy cells that multiply rapidly, especially in bone marrow, hair follicles, skin, and the linings of the mouth and intestines, among other areas. This is largely what causes chemotherapy side effects.

Nausea, Vomiting, GI Issues

In addition to nausea and vomiting, constipation and diarrhea are also common side effects of chemotherapy.

Anti-nausea and GI medications can be administered before, during, and after treatment. You may also try complementary therapies like meditation and somatic exercises.

Mouth and Throat Sores (Mucositis)

Brush your teeth several times a day with fluoride toothpaste, using a soft toothbrush or a sponge on a stick. Gargle with baking soda rinse (½ tsp of salt and ½ tsp of baking soda in a glass of water). Choose foods that are soft, lukewarm, and non-acidic.

Lack of Appetite, Taste changes, and Weight loss

It’s normal for mesothelioma patients to experience weight loss and lack of appetite. But it’s something that should be addressed, as this can make you weaker and make treatments less effective.

Focus on eating high-calorie, high-protein foods, and eat 4-6 small meals a day. Experiment to find food that’s appetizing and utilize nutrition shakes.

You can also check out our full guide on nutrition and mesothelioma.

Fatigue, Cognitive Effects, and “Chemo Brain”

Chemotherapy often causes fatigue (abnormal exhaustion not resolved with rest), as well as “chemo brain”, cognitive changes including impaired thinking, memory, and attention, mental fogginess, and difficulty speaking clearly or finding the right words.

Consult with your care team about potential medication adjustments and check for vitamin deficiencies. Get healthy sleep, socialization, and as much exercise as possible. Stick to a daily routine, utilize memory supports (i.e., writing things down or having others remind you), and do cognitive exercises (i.e., challenging games like crossword puzzles and Wordle).

Hair Loss

Some chemotherapy drugs may cause hair loss, usually starting within weeks of your first treatment, and continuing for several weeks after your last treatment. Some patients experience scalp irritation or itchiness during hair loss.

Some patients use a scalp cooling cap during infusions, which may reduce follicle damage and hair loss. Consider shaving your head early in the process to reduce itching as hair falls out.

Headaches, Muscle Aches, and Soreness

Pursue palliative care with your mesothelioma team. They may adjust your chemo regimen, address other underlying medical issues, or prescribe medication, nerve blocks, PT, or other pain-relief therapies.

Skin Issues

Dry skin, itchy skin, and redness are all common side effects of chemo. Discoloration, rashes, peeling, and photosensitivity are also common.

Use sunscreen and gentle moisturizer to protect your skin. Avoid direct exposure to the sun. Use cool washcloths or colloidal oatmeal baths in lukewarm water. Ask about corticosteroids or antibiotics in severe cases.

Rare and More Severe Side Effects of Chemotherapy

Some side effects of chemotherapy are somewhat rarer but can be much more serious and can cause longer lasting and potentially permanent issues.

You should always consult your mesothelioma care team about these symptoms, including:

Peripheral Neuropathy

Some chemotherapy drugs can cause nerve damage (peripheral neuropathy) that may lead to hearing loss, loss of balance, and problems seeing, hearing, or walking normally, as well as pain, burning, tingling, numbness, hot-and-cold sensitivity, and weakness in the hands and feet.

For some patients, symptoms only last for a short time after treatment. For others, symptoms can last much longer and may potentially become permanent.

Symptoms can also worsen over time, and chemotherapy drugs must often be adjusted to avoid doing additional nerve damage. Always inform your mesothelioma care team if you experience any of these symptoms.

Heart Problems

Some chemotherapy medications may damage the heart, causing associated cardiac problems. Older mesothelioma patients (those aged 60+) are more vulnerable to chemo-related heart issues.

Your doctor should test your heart before, during, and after treatment to monitor your cardiac health.

Blood Disorders

Chemotherapy can damage bone marrow, which is the tissue inside bones that makes new blood cells. As such, during chemotherapy, mesothelioma patients generally don’t produce enough blood cells.

This can cause conditions requiring medical attention. These include:

Anemia (caused by too few red blood cells, with symptoms like fatigue, dizziness, and shortness of breath).
Leukopenia (increased chance of infection, caused by too few white blood cells).
Thrombocytopenia (caused by too few blood platelets, which can cause easy bruising or bleeding).

Your doctor will continually check your blood cell counts using tests called the complete blood count (CBC) and the platelet count. Blood cell counts usually return to normal after chemotherapy but must be addressed if they do not do so.

Your doctor and your mesothelioma care team will be available to you throughout your chemotherapy journey. If you are confused or concerned about your symptoms, the course of your treatment, and the chemotherapy process in general, reach out to your care team.

Are you or a loved one looking for more information about mesothelioma lawsuits? Call us at 855-385-9532, locally 502-589-5600, or contact us online to arrange a free initial consultation with a Satterley & Kelley PLLC lawyer.