Chemotherapy Treatment Option for Mesothelioma
Chemotherapy, also known as systemic therapy, is administered either orally or by infusion to kill any cancer cells that are in the body, and there are a variety of medications. Although it is not curative it has proven to help increase the survival rate. Chemotherapy is also used to reduce pain and improve the patient’s quality of life.
A medical oncologist, who is a specialist in nonsurgical treatments meets with the patient after diagnosis. The goal is to determine the best course of treatment. This will be determined by various testing procedures, the patient’s tolerance, and overall health. The standard treatment for mesothelioma is chemotherapy because it is designed to do several things:
- Kill mesothelioma cells
- Prevent cancerous cells from spreading
- Make other treatments more effective, such as surgery
- Shrink tumors
- Relieve pain
- Help increase the survival rate
- And improve the patient’s quality of life.
Various types of Chemotherapy available
Chemotherapy is the most traditional approach to treat all types of cancer and has greatly improved in the treatment of mesothelioma. When chemotherapy is combined with other treatments, it improves the rate of survival. Chemotherapy can also be adjusted using different types of medication depending on the patient’s tolerance.
Neoadjuvant therapy is given to patients prior to their primary therapy this can improve the results by reducing the size of tumors which increases the chances of complete tumor removal after surgery.
Radiation therapy is used in all patients with mesothelioma, but is especially beneficial to patients that have advanced stages of cancer. It is used to shrink the growth of tumors in early stages and in advanced stages it helps relieve pain in patients. Radiation techniques have developed that can target tumors directly and spare healthy cell tissue.
Adjuvant therapy is usually given after primary cancer treatment in order to prevent the cancer from returning. This is often done immediately after surgery. Because there are still microscopic cancer cells left behind, mesothelioma is likely to return. Chemotherapy right after surgery attempt to kill the cancer cells that have been left behind.
Intraoperative chemotherapy is chemotherapy that is administered while the patient is in surgery. Doctors will apply high doses of chemotherapy directly to the tumors and there are less side effects.
Patients can expect to be administered 3-4 rounds of chemotherapy which is administered in the hospital, at outpatient facilities, at cancer treatment centers or at home. If serious side effects occur chemotherapy is stopped. Doctors and nurses monitor the patient to make sure there is no discomfort and watch for unusual side effects.
In the case of pleural mesothelioma, the doctor might infuse medication directly into the chest cavity. This is called pleural chemotherapy. In the abdomen it is called intraperitoneal chemotherapy.
- Kill mesothelioma cells
- Prevent cancerous cells from spreading
- Make other treatments more effective, such as surgery
- Shrink tumors
- Relieve pain
Specific chemotherapy drugs on the market
Chemotherapy treatment for patients with mesothelioma is somewhat new. Chemotherapy drugs are generally given in two combinations because when chemotherapy drugs were combined studies revealed that the combination showed significant effect. However if a patient is not healthy enough for a combination dose, one drug can be administered.
Chemotherapy has to be tailored each patient. Some have more tolerance and less side effects than others. Each patient is different and if a patient can’t manage combination chemotherapy drugs, they are often started out with just one. Doctors often try different drugs and different combinations on patients to find the most effective course of treatment. What works for one patient may have no effect on another. The doctor’s goal is to kill the cancer cells while still protecting the health of the patient.
Alimta and cisplatin – This combination is the standard treatment for patients with mesothelioma. Alimta (Pemetrexed) is one of the newer chemotherapy medications and was approved by the FDA in 2005. Alimta is the first medication that was approved specifically for mesothelioma. It is the most effective treatment for pleural mesothelioma patients that are unable to have surgery.
Alimta is administered to patients on an outpatient basis every 21 days. It is administered by a 10 minute IV infusion followed by two hours of Cisplatin. The patience response will determine the number of cycles required.
Carboplatin – This drug is popular with physicians because the side effects are less severe than most other chemotherapy drugs. It is administered through and IV on an outpatient basis once every 28 days. If more frequent treatment is necessary than Carboplatin is combined with other drugs. Anyone with kidney disease should not use this drug.
Navelbine (Vinorelbine) – This treatment was first approved for the treatment of breast cancer but is also used to treat lung cancers. Navelbine interferes with cancer cells as they are in they are dividing. This interference kills the cancer cells faster and stops the growth of tumors. It is given by IV and redness or burning at the infusion sight can occur.
Gemcitabine – is usually used to treat pancreatic, breast and ovarian cancer, however doctors have found that this drug has been effective in treating pleural and peritoneal mesothelioma. Gemcitabine targets rapidly dividing cells and can ultimately slow the growth of pleural mesothelioma. It is administered on an outpatient basis through an IV. The treatment takes a couple of hours. Gemcitabine is usually given once a week for approximately seven weeks.
Doxorubicin – has been approved by the FDA since about 1984. It has been used to treat bone, bladder, breast cancer and many other cancers. It is administered through an IV and takes about 15 minutes. It is generally given about once a month.
It is difficult to say which drugs are best for treating mesothelioma patients because there are so many factors that differentiate one patient from another. Alimta and cisplatin are the two that are most used in chemotherapy treatment, but depending on the patients overall health, this may not be the best course of treatment for that patient.
How chemotherapy is administered
This can be accomplished in a variety of ways. The method of administration a patient receives is based on the location of the cancer, the type of mesothelioma, and overall health of the patient.
- Intravenous Delivery – This is the most common method in which chemo is administered. It may be either an injection or an IV drip and delivery can take from minutes up to a few hours.
- Medical Port – Patients who have had their treatment extended may be fitted with a port. This makes delivery quicker and easier.
- Oral Delivery – The most convenient method of chemotherapy delivery is by oral medication. However this is currently only available in clinical trials.
There are risks and benefits to chemotherapy. The risks are unpleasant sometimes intolerable side effects during treatment. The benefit is that the treatment can extend a patient’s life and sometimes send mesothelioma into remission. Chemotherapy introduces chemicals into the patient’s bloodstream where it attacks cancer cells. However, it also attacks healthy cells and there is no way to prevent that. The attack on the healthy cells is the cause of the side effects in the patient.
Mesothelioma cancer is a very difficult cancer to manage and often the side effects of treatment are severe depending on the patient, their overall health, the type of drug being used, and the patient’s response to the medication.
After the first session of chemotherapy patients may notice some mild effects. Generally, the severe side effects develop once a person has completed a full cycle of treatment. The milder symptoms are managed by changing the diet, exercise, over-the-counter medications and rest. Patients may develop some or all of the following side effects:
General Side Effects for Chemotherapy
- Fatigue – the most common side effect of chemotherapy is fatigue. It effects up to 96 percent of cancer patients. Fatigue is considered a normal side effect, but the patient should contact their doctor if they feel faint, dizzy or short of breath.
- Nausea and Vomiting – These symptoms affect about 70-80 percent of patients undergoing chemotherapy. Sometimes the symptoms occur immediately after administration or they may develop several days later. They can last from a few hours up to a week.
- Mouth Sores – Chemotherapy drugs often damage cells on the inside of the mouth which causes problems with the patient’s teeth and gums. Mouth sores can make it difficult to drink, eat, and swallow. This can be exacerbated if the patient had poor oral hygiene prior to beginning treatment.
- Diarrhea and Constipation – Diarrhea and constipation occur because the drugs irritate the lining of the gastrointestinal wall. Prolonged diarrhea can cause the imbalances in the body. Over-the-counter medications are usually enough to treat these side effects.
- Hair Loss – Patients worry about losing their hair as this is the most common side effect of chemotherapy. While other symptoms are treatable, hair loss is not. During treatment many patients opt for wigs.
- Blood Cell Side Effects – After the first dose of treatment is administered, white blood cells, red blood cells, and platelets can be affected. The most common is a drop in white blood cells which leaves the patient more susceptible to infection.
- Emotional Effects – Things such as hair loss, constant fatigue and weight changes often lead patients to struggle with their self-esteem which leads to depression and anxiety. 15-25 percent of patients being treated for cancer report that they felt depressed both during and after treatment.
- Memory Problems – Many patients have reported having memory problems during treatment as well as a general state of “fogginess”. The effects on the brain are different for everyone and so the length of time these effects last will vary.
What is Chemo Brain?
Chemo brain, also known as hyperbarics, refers to memory and thinking problems that occur after a patient undergoes cancer treatment, particularly chemotherapy treatment. Learn more about chemo brain, here.
Chemotherapy Side Effects Related to Specific Drugs
- Alimta – A small percent of patients experience tingling in the toes and fingertips, rash, and mouth sores.
- Carboplatin – Black tarry stool and lower back or side pain, a red rash, ringing in the ears and blurred vision.
- Cisplatin – Fast heartbeat, lower back or side pain, rash, swollen feet, face, or lower legs, joint pain, loss of taste
- Doxorubicin – Tearing of the eyes, flushed face, yellowing skin, body stiffness and darkening of the nail beds.
- Navelbine – About five percent of patients experience jaw pain, loss of deep tendon reflexes and pain at injection site.
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