When doctors combine chemotherapy with other treatments, like surgery or radiation therapy, they do so in 3 ways: neoadjuvant, intraoperative, and adjuvant. The method used depends on the cancer stage and location of the mesothelioma.
- Neoadjuvant - Doctors use neoadjuvant chemotherapy to shrink mesothelioma tumors before surgery. It allows them to remove the tumor more easily and efficiently.
- Intraoperative - Doctors use intraoperative chemotherapy during surgery. Administering chemotherapy during a surgical procedure makes it more effective because it allows specialists to apply stronger doses of the cancer-killing drug directly to a tumor. This also causes less side effects because less healthy cells are harmed during the process.
- Adjuvant - Doctors use adjuvant chemotherapy to kill cancer cells that may have been left behind after surgery. They use chemotherapy to “clean up” stray cancer cells and reduce the risk of cancer recurring.
Single Agent and Combined Chemotherapy
Doctors also use chemotherapy by itself, as a single agent, to reduce pain caused by symptoms of mesothelioma. Single agent chemotherapy is a first-line treatment for patients who aren’t eligible for surgery due to the advanced stage of their mesothelioma.
Medical studies have shown that combining two or more chemotherapy drugs increases survival rates more than the use of a single drug. In one study, researchers reported that the combination of Alimta and cisplatin improved the overall survival rate of patients over the use of cisplatin alone.
The combination of Alimta and cisplatin produced an overall survival rate of 12.1 months while cisplatin alone produced a survival rate of 9.3 months.
Medical researchers are always testing new combinations of chemotherapy drugs to find one that works the best. In a recent clinical trial, they used oxaliplatin and gemcitabine, producing an overall survival rate of 14 months in patients with pleural mesothelioma.
Doctors use 2 methods to give chemotherapy to their patients. The way the doctor administers the drugs is based on the patient's overall health, tolerance to certain drugs, and the cancer stage of the mesothelioma.
Doctors place regional chemotherapy directly into the area affected by mesothelioma. For patients with pleural mesothelioma, they administer cancer-killing drugs in the space between the inner and outer lining of the lung. For those with peritoneal mesothelioma, chemotherapy is used between the linings of the abdomen. Regional chemotherapy is beneficial because fewer healthy cells — especially those in the area surrounding the tumor — are damaged by the drug. This results in fewer side effects and faster recovery times.
Patients take systemic chemotherapy by mouth, using pills, or through an IV. After the drug is ingested, it circulates through the bloodstream, attacking cancer cells. Though systemic chemotherapy is effective in reducing the size of mesothelioma tumors, it has a drawback: increased side effects.
Systemic chemotherapy can’t differentiate between cancer cells and healthy cells. The side effects of systemic chemotherapy is caused by damage to healthy cells. Fortunately, symptoms start to disappear as soon as a patient finishes chemotherapy.
Side effects occur when chemotherapy drugs damage healthy cells as they attack and kill mesothelioma. Patients react to chemotherapy in different ways, depending on their tolerance for the drug they’re taking.
A few general side effects caused by chemotherapy include:
- Nausea and vomiting
- Hair loss
- Mouth sores
Side effects caused by chemotherapy are temporary and will disappear after treatment is completed. If you’re currently taking chemotherapy — or plan to in the future — there are several ways to manage or prevent side effects.
Easing nausea and vomiting
- Eat a light meal before treatment, or request anti-nausea medication your doctor.
- Try not to eat overly sweet or fried or foods, and stay away from those high in fat.
- Drink plenty of fluid and eat a healthy meal before treatment.
- Go on short walks.
- Plan on taking short naps, and try to conserve as much energy as possible.
Dealing with hair loss
- Use mild shampoo, and try not to use heavy dyes.
- Wear a hat or scarf.
Taking care of mouth sores
- Use a soft toothbrush after eating.
- Try not to eat acidic or spicy foods, like citrus or tomatoes.
- Schedule an appointment with a dentist before receiving chemotherapy.
- Take care of any existing mouth sores with prescription medicine.
Chemotherapy in Clinical Trials
Researchers are currently testing combinations of chemotherapy drugs and new, experimental treatments in clinical trials. Combining chemotherapy with new treatments, like immunotherapy, increases patients’ treatment options and may lead to a cure in the future.
In a recent medical study, researchers successfully combined cisplatin and MK-1775, an immunotherapy treatment. The combination significantly increased the cancer-killing effectiveness of cisplatin. Researchers are also testing the combination of pemetrexed (Alimta), cisplatin, and CRS 207, a vaccine that attacks a protein abundant in mesothelioma.
Speak to a member of our Patient Help Team to learn more about how you can participate in clinical trials. A member of our team can also review your diagnosis, connect you to experienced doctors, and help find financial aid that can pay for treatment. Get started on improving your diagnosis today.
- Drugs Approved for Malignant Mesothelioma. Retrieved on July 20, 2014 from http://www.cancer.gov/cancertopics/druginfo/malignantmesothelioma.
- Chemotherapy drugs for mesothelioma and their side effects. Retrieved on July 20, 2014 from http://www.cancerresearchuk.org/cancer-help/type/mesothelioma/treatment/chemotherapy/chemotherapy-drugs-for-mesothelioma-and-their-side-effects.
- Anna, N. (2012). “Chemotherapy for malignant pleural mesothelioma: A review of current management and a look to the future.” Annals of Cardiothoracic Surgery, 1(4). Retrieved July 21, 2014, from http://www.annalscts.com/article/view/1056/1585.
- Grosso, F. (2012). “Systemic Treatment of Malignant Pleural Mesothelioma.” Future Oncology, 8(3). Retrieved July 20, 2014, from http://www.medscape.com/viewarticle/760664_1.