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.

Fact-Checked and Medically Reviewed By: Dr. Mark Levin

Chemotherapy Treatment Goals

The primary goal of chemotherapy is to target and kill off mesothelioma cells so they cannot spread throughout the body. Inhibiting cancer cell growth also helps to shrink tumors and reduce painful symptoms associated with tumor growth.

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

Duration: 1 min 11 sec

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.

Chemotherapy can be used as first- or second-line treatment. It can either serve as a patient’s primary treatment or it can play a supportive role with other mesothelioma treatments like surgery and palliative therapy.

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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.

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 or more chemotherapy drugs rather than just one often results in longer survival rates.
  • Chemotherapy after surgery can improve survival rates.
  • Chemotherapy is given in cycles that last 2-3 weeks with a rest period in between.

Benefits of Chemotherapy for Mesothelioma

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.

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Survival Rates with Chemotherapy Alone

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. The standard treatment for the remaining 80% is chemotherapy by itself with a median survival rate of 12 months.[/callout]

For patients whose mesothelioma is caught in the earlier stages and who 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.

“Open and frank communication between physician and patient about when to cease chemotherapy was recommended, as it was found that patients who received chemotherapy at the end of life had shorter survival compared to those who did not.”

Chemotherapy Drug Types 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.

Several chemotherapy drugs can treat mesothelioma. Doctors prescribe certain drugs — or combinations of drugs — based on the desired treatment outcomes and how they reinforce one another.

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.

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 social worker or a a legal professional.

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Side Effects of Chemotherapy

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:

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

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.

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 vitamins or supplements that they take.

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.

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

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.

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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.

Standard chemotherapy treatment is similar for all types of mesothelioma — pleural, peritoneal, pericardial, and testicular.

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 (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. Some doctors recommend also this procedure for patients who undergo a pleurectomy and decortication (P/D).
  • 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 main 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 abdominal 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.

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.

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.

Learn More About Chemotherapy for Mesothelioma

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

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

Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has over 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.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author

Mesothelioma Hope was founded by a team of passionate health advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. Our team works tirelessly to give hope to those impacted by mesothelioma. Learn more about operating principles and our Editorial Guidelines.

5 References
  1. Darlison, L., Taylor, B., Harrison, M., Gardiner, C., & Ejegi-Memeh, S. (2021). Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review. Retrieved April 15, 2021, from





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