Most mesothelioma patients undergo standard chemotherapy, which can kill mesothelioma cells and prevent them from spreading. Patients usually receive a combination of chemotherapy drugs, including “front-line” drugs—proven combinations for combating mesothelioma.

The current first-line combination is cisplatin and pemetrexed (Alimta), which has proven to best improve survival in mesothelioma patients.

How Chemotherapy for Mesothelioma Works

Chemotherapy fights mesothelioma at many disease stages. The doctor will customize the drug combination depending on the patient. For example, patients in the early stages of mesothelioma are often prescribed multimodal therapy, as they are able to endure higher levels of treatment.

How doctors administer chemotherapy varies from patient to patient. For example, intrapleural chemotherapy involves inserting chemotherapy drugs directly into the chest cavity, while intraperitoneal chemotherapy involves inserting chemotherapy drugs into the abdomen.

Unfortunately, the first-line treatments are not always able to fight cancer on their own. After first-line therapy or aggressive multimodal therapy, patients often stop responding to treatment. Many patients will choose to undergo second-line chemotherapy at this point.

What Is Second-Line Chemotherapy for Mesothelioma?

Second-line chemotherapy refers to the combination of chemotherapy drugs doctors prescribe after patients stop responding to first-line treatments. Second-line treatments are also an option for patients who are experiencing severe side effects that make it unreasonable for them to continue on the original treatment plan.

Some chemotherapy drugs used as second-line treatments include:


Carboplatin (often sold as Paraplatin or Paraplatin Nova Plus) was derived from cisplatin by Dr. Tom Connors and Dr. Ken Harrap of Michigan State University in the 1970s. It has the same benefits as cisplatin, but is less toxic and causes fewer side effects.

While it’s usually used to treat ovarian cancer and stop it from spreading into the abdomen, carboplatin has proven effective in treating mesothelioma.

Carboplatin stops mesothelioma cells from replicating by attacking them at a genetic level, killing them off and slowing down cancer growth. It is often combined with Alimta (another chemotherapy drug) to amplify its effects.


Gemcitabine (Gemzar) is a chemotherapy medication originally used to treat breast, ovarian, pancreatic and non-small cell lung cancers. It can be given to mesothelioma patients on its own and its effects, when combined with cisplatin, are currently being tested.

Gemcitabine interferes with the cancer cell’s metabolic process to prevent replication. It has so far shown promising results in pleural mesothelioma patients. Some mesothelioma specialists are hopeful it will be an effective pericardial mesothelioma treatment.


Onconase (ranpirnase) is an enzyme-based drug. It’s currently being tested and has yet to be FDA approved. This chemotherapy drug differs from others in the way it attaches to cancer cells and spares healthy cells. Onconase is still undergoing clinical trials for mesothelioma.

Testing Second-Line Chemotherapy in Clinical Trials

Clinical trials test new treatments and treatment combinations as well as testing other cancer treatments in mesothelioma treatment. Clinical trials testing second-line chemotherapy for mesothelioma can offer renewed hope for patients.

The results from clinical trials help researchers develop new and improved treatment methods for patients who don’t respond to standard therapy.

If you are interested in participating in a clinical trial to receive second-line chemotherapy treatment options for mesothelioma, contact our Patient Advocates today.

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Laura WrightWritten by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 15 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

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  1. Science Direct Journal of Thoracic Oncology, “Pemetrexed as Second-Line Treatment in Malignant Pleural Mesothelioma After Platinum-Based FIrst-Line Treatment” Retrieved from Accessed on July 18, 2018

  2. US National Library of Medicine National Institutes of Health, “Chemotherapy for Malignant Pleural Mesothelioma: a Review of Current Management and a Look to the Future” Retrieved from Accessed on July 18, 2018

  3. US National Library of Medicine National Institutes of Health, “Life After First-Line Chemotherapy in Malignant Pleural Mesothelioma: A North-East England Experience” Accessed on July 18, 2018

  4. US National Library of Medicine National Institutes of Health, “Second-Line Treatment for Pleural Mesothelioma” Retrieved from Accessed on July 18, 2018

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