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Mesothelioma Chemotherapy Drugs

Doctors can use mesothelioma chemotherapy drugs to shrink tumors and help patients live longer. Some of the best chemotherapy drugs include pemetrexed and cisplatin (Alimta®). Chemotherapy medications can be used alone or with other treatments like immunotherapy to improve survival. Find top chemotherapy drugs for your diagnosis with our help.

Medically reviewed by: Assuntina Sacco, MD

Last updated:

What Are the Different Types of Mesothelioma Chemotherapy Drugs?

One of the most important treatments for mesothelioma is chemotherapy, or chemo, which involves administering medications to destroy tumors and kill cancer cells.

Your oncologist (cancer doctor) can choose from different types of mesothelioma chemotherapy drugs when developing your treatment plan.

Notable mesothelioma chemotherapy drugs include:

Which chemotherapy medications will be used depends on factors like your type of mesothelioma, cancer stage, and overall health.

Key Facts on Mesothelioma Chemotherapy Drugs

  • Uses: Mesothelioma chemotherapy medications can be used alone, in combination with one another, or alongside other treatments to increase life expectancy.
  • Possible side effects: Certain types of chemo drugs for mesothelioma can cause side effects like hair loss and fatigue, but your medical team can help you manage these as they come up.
  • Impact on survival: Malignant pleural mesothelioma patients treated with the drugs pemetrexed and cisplatin or carboplatin live for 14.1 months on average. You may live longer depending on what treatments you receive and how your cancer responds to them.

Use our Free Doctor Match to find specialists who can treat mesothelioma with different chemotherapy drugs.

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8 Types of Mesothelioma Chemotherapy Drugs

There are several types of mesothelioma chemotherapy drugs. Learn about each and when they’re used below.

1. Cisplatin

Cisplatin is one of the most commonly used mesothelioma chemo drugs. In 2004, the U.S. Food and Drug Administration (FDA) approved it in combination with pemetrexed to treat pleural mesothelioma, which develops in the lung lining.

Cisplatin contains platinum, which binds to the DNA of mesothelioma cells and damages it, preventing the cancer from spreading.

A 2021 study found that pleural mesothelioma patients treated with cisplatin lived for 9.3 months, according to a report published in JCO® Oncology Practice. However, since patients usually live longer when pemetrexed and cisplatin are combined, it’s rarely used as a standalone treatment.

2. Pemetrexed (Alimta®)

Pemetrexed, alongside cisplatin, is FDA-approved for pleural mesothelioma and has been in use for over 20 years. This type of chemotherapy drug works by blocking proteins found in cells called enzymes.

Mesothelioma cancer cells use these enzymes to produce DNA, so when pemetrexed blocks them, the cells start to die.

“Systemic chemotherapy with pemetrexed and cisplatin has been the cornerstone of treatment for advanced pleural mesothelioma since 2004.”

- Quote from Dr. Hedy Lee Kindler, mesothelioma specialist

The combination of pemetrexed and cisplatin is one of the most common first-line treatments (initial therapies used after a diagnosis) for pleural mesothelioma.

3. Carboplatin

Carboplatin treats mesothelioma in a similar way to cisplatin, as both contain platinum. However, carboplatin is much less potent than cisplatin, meaning patients have a lower risk of side effects.

For this reason, carboplatin is often substituted for cisplatin in older or frail patients.

Many mesothelioma patients treated with carboplatin and pemetrexed live just as long as those treated with cisplatin and pemetrexed, according to a study featured by the International Association for the Study of Lung Cancer (IASLC).

4. Doxorubicin

This mesothelioma chemotherapy drug inserts itself into the DNA of cancer cells to destroy them. It also hinders the enzymes of cancer cells, which damages the cells’ ability to make DNA and RNA.

It’s commonly used alongside cisplatin to treat peritoneal mesothelioma, which forms in the abdominal cavity.

5. Gemcitabine (Gemzar®)

Gemcitabine tricks mesothelioma cells into using the wrong molecules to make their DNA, preventing them from multiplying and leading to cell death.

This type of chemotherapy is commonly used as a second-line treatment option, meaning it’s used if a patient’s cancer comes back after other therapies have failed.

Pleural mesothelioma patients treated with gemcitabine and immunotherapy lived for 13.8 months, according to a 2021 study published in CancerNetwork. All of the patients in the study had been treated with chemotherapy before.

6. Onconase (Ranpirnase)

This type of chemotherapy affects how cancer cells use a genetic material known as RNA, which leads to cell death. It is derived from frog eggs.

It also enhances the anticancer effects of traditional mesothelioma chemotherapy medications.

Onconase is currently being studied in clinical trials to treat mesothelioma patients.

Mesothelioma researchers are optimistic about Onconase because it doesn’t have as many side effects as other chemotherapy drugs.

7. Pegargiminase (ADI-PEG20)

A new mesothelioma chemotherapy drug called pegargiminase (ADI-PEG20) is being hailed as a breakthrough after positive results in clinical trials for pleural mesothelioma.

In the phase III ATOMIC-Meso trial, ADI-PEG20 quadrupled 3-year survival rates, increased life expectancy, and reduced the risk of cancer progression.

One patient was told he only had 4 months to live, but thanks to ADI-PEG20 he has now become a 5+ year mesothelioma survivor.

The medication works in combination with pemetrexed and cisplatin and starves cancer cells of an amino acid critical for their growth. Cancer research is continuing to study how ADI-PEG20 could join other chemotherapy drugs as a standard mesothelioma treatment.

8. Vinorelbine (Navelbine®)

Vinorelbine damages the structure of cancer cells, stopping them from spreading. Like gemcitabine, it’s typically used if a patient’s cancer returns after prior treatments.

Pleural mesothelioma patients treated with vinorelbine had a longer progression-free survival (meaning their cancer was stable for longer) than those who only received supportive care for their symptoms, based on a 2022 study published in eClinicalMedicine.

Use our free checklist of 14 Questions to Ask Your Doctor to get more information about mesothelioma chemotherapy drugs that could help you or a loved one.

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Combinations of Mesothelioma Chemotherapy Drugs

Doctors may use two or more malignant mesothelioma chemotherapy drugs together to help patients live longer.

Combinations of mesothelioma chemo drugs include:

  • Pemetrexed and cisplatin: This is the most common chemotherapy combination. Pleural mesothelioma patients typically live longer than if they received just one of either drug. The average life expectancy for patients treated with this combination is 15.5-16.5 months.
  • Pemetrexed and carboplatin: If a patient can’t safely receive cisplatin due to the risk of side effects, doctors may use carboplatin with pemetrexed to improve survival.
  • Doxorubicin and cisplatin: Doctors commonly use these two drugs together when administering hyperthermic intraperitoneal chemotherapy (HIPEC) to treat peritoneal mesothelioma.
  • Gemcitabine and cisplatin: Pleural mesothelioma patients treated with this combination of chemo drugs lived for over 16 months in a 2021 study published in Frontiers in Oncology. A low-dose, continuous infusion of both drugs was also cheaper than alternatives like pemetrexed and cisplatin.

Multiple mesothelioma chemotherapy drugs can be used at different times throughout a patient’s treatment plan.

For example, one pleural mesothelioma patient was able to become a 10-year survivor after receiving pemetrexed, cisplatin, vinorelbine, and carboplatin over several years. This chemotherapy drug combination helped beat the man’s cancer multiple times, as noted in a 2023 Thoracic Cancer report.

How Chemotherapy Drugs Work in Mesothelioma Treatment Plans

Chemotherapy drugs are much more commonly used as part of a larger mesothelioma treatment plan.

Different chemotherapy drugs may be used:

  • As a patient’s main treatment: Chemotherapy drugs like cisplatin and pemetrexed are often the main treatments used for pleural mesothelioma patients whose cancer is advanced.
  • Before surgery: Doctors may use chemotherapy to shrink tumors so they’re easier to remove with surgery. Pleural mesothelioma patients treated with pemetrexed and cisplatin before pleurectomy with decortication (P/D) surgery lived for over 3 years, according to a 2022 report published in The Journal of Thoracic Surgery.
  • After surgery: Chemotherapy can be used following surgery to destroy remaining cancer cells. For example, a heated solution of cisplatin and doxorubicin can be administered after cytoreductive surgery to treat peritoneal mesothelioma. This is called cytoreduction with HIPEC, and patients who have this procedure live for more than 4 years on average.
John Stahl
Point of Hope

Stage 4 mesothelioma patient John Stahl has survived for over 4 years with chemotherapy as his main treatment. Though he experienced side effects, he says he is “pretty well back to normal” today.

Doctors may also combine chemotherapy with radiation therapy, immunotherapy, and alternative or holistic cancer treatments to improve a patient’s life expectancy.

Call (866) 608-8933 to speak with one of our in-house registered nurses about if mesothelioma chemotherapy treatments may be able to help you or a loved one.

Side Effects of Chemotherapy Drugs for Mesothelioma

All chemotherapy cancer drugs come with a risk of side effects. This is because they damage healthy cells in the process of killing cancerous ones.

Here are common side effects for each mesothelioma chemotherapy drug:

  • Cisplatin: Difficulty breathing, dizziness, fatigue, loss of appetite, pain, rashes, and vomiting
  • Carboplatin: Hair loss, loss of taste, low magnesium levels, and low blood cell counts
  • Doxorubicin: Fatigue, hair loss, nausea, and vomiting
  • Gemcitabine: Cough, diarrhea or constipation, fever, and pain
  • Onconase: Chills, diarrhea, weakness, weight loss, and constipation
  • Pemetrexed: Chest pain, difficulty breathing, fever, headaches, and mouth sores
  • Vinorelbine: Blood in urine or fecal matter, chills, chest pain, headaches, and skin rashes

Not everyone experiences these side effects, and if you do, supportive care and medications can help make them more manageable.

“It’s important to keep a good relationship with your oncologist (cancer doctor) and be knowledgeable going into chemotherapy about the possible side effects.”

- Quote from Amy Fair, RN, Mesothelioma Hope Patient Advocate

Mesothelioma Chemotherapy Drugs in Clinical Trials

Clinical trials are testing new chemotherapy drugs for mesothelioma as well as changes or improvements to existing medications.

While there are no guarantees, mesothelioma clinical trials may allow qualifying patients to access chemotherapies that are potentially more effective. This is very important for patients whose cancer hasn’t responded well to other treatments.

Some current mesothelioma chemotherapy clinical trials include:

  • Chemotherapy With or Without Immunotherapy for Peritoneal Mesothelioma: This ongoing trial is studying if combining chemotherapy drugs like cisplatin with immunotherapy medications may help patients live longer.
  • Magnesium for the Prevention of Kidney Damage in Patients Undergoing Surgery with Cisplatin: Here, doctors want to learn if giving magnesium will help prevent cisplatin from damaging the kidneys when used intraoperatively.
  • A Study of Additional Chemotherapy After Surgery for People With Malignant Peritoneal Mesothelioma: Doctors are investigating whether pemetrexed and cisplatin or carboplatin are more effective if given intravenously (through the arm) or intraoperatively (directly at the surgery site) after surgery.

Use our Free Doctor Match to connect with doctors who specialize in mesothelioma chemotherapy and have experience with clinical trials.

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How Are Mesothelioma Chemotherapy Drugs Administered?

Chemotherapy medications for mesothelioma can be given systemically or locally. Learn about each approach to chemotherapy below.

Systemic Chemotherapy Drugs for Mesothelioma

Systemic mesothelioma chemotherapy drugs circulate throughout your entire bloodstream, destroying any cancer cells in their path.

Systemic chemo drugs can be given:

  • By mouth
  • By pill
  • Through an intravenous injection (IV)

Doctor adjusting chemotherapy dosage

Most mesothelioma chemotherapy drugs, including pemetrexed, cisplatin, and carboplatin, can be given systemically.

Systemic chemotherapy is administered in cycles. In a cycle, you’ll receive a dose of chemotherapy and then have a rest period before getting the next dose. The rest period allows your body to recover.

Pleural mesothelioma patients typically get 2-4 cycles of pemetrexed and cisplatin through an IV once every three weeks, according to NYU Langone’s Perlmutter Cancer Center. Different chemotherapies may be used if the cancer comes back after these cycles.

Local Chemotherapy Drugs for Mesothelioma

Local (or regional) chemotherapy focuses on killing cancer cells in a specific area of the body.

This type of chemo has milder side effects but is best used on earlier-stage cancers that have not spread very far.

A common form of local mesothelioma chemotherapy is the use of cisplatin and doxorubicin in HIPEC to treat peritoneal mesothelioma. Research is also looking into how localized hyperthermic intrathoracic chemotherapy (HITHOC) can help pleural mesothelioma patients.

Find the Best Mesothelioma Chemotherapy Drugs for Your Case

Mesothelioma chemotherapy drugs like cisplatin and pemetrexed often play a big role in treatment plans.

Different mesothelioma chemotherapy medications can:

  • Fight cancer that has metastasized (spread to other areas)
  • Make other treatments more effective
  • Possibly help you live longer
  • Reduce pain and other symptoms
  • Slow or stop the spread of cancer

Our registered nurses and Patient Advocates can help you understand which chemotherapy drugs could be best for your case. We can also connect you with top mesothelioma doctors who use chemotherapy to treat this cancer.

Call (866) 608-8933 to connect with our team or use our Free Doctor Match to find top chemotherapy specialists. The hope you need after a mesothelioma diagnosis is waiting for you.

Chemotherapy Drugs for Mesothelioma FAQs

What is the best chemotherapy for mesothelioma?

There isn’t one mesothelioma chemotherapy drug that is considered the best. Many chemotherapy medications, including pemetrexed, cisplatin, carboplatin, and gemcitabine, can help mesothelioma patients live longer.

Which chemotherapy drug will work best in your case depends on where the cancer has formed in your body, if and how far it’s spread, and other factors.

What is first-line chemotherapy for mesothelioma?

The most common first-line chemotherapy drugs for mesothelioma are pemetrexed and cisplatin. The U.S. Food and Drug Administration (FDA) approved this combination of chemotherapy in 2004 to treat pleural mesothelioma.

Your cancer care team can give you a better idea as to which chemotherapy drug(s) will be a part of your first-line treatment plan.

Is it worth having chemo for mesothelioma?

This depends on the specifics of your diagnosis, but many other patients have benefitted from getting chemotherapy for malignant mesothelioma.

Chemotherapy medications can help extend life expectancy and improve quality of life. While chemotherapy treatments can cause side effects, your oncology team will make sure you get the care needed to manage them.

What new drugs are being given for mesothelioma?

A promising new drug for mesothelioma is pegargiminase, or ADI-PEG20, which has shown excellent results in the recent ATOMIC-Meso clinical trial.

In fact, mesothelioma patients who received this drug along with pemetrexed and cisplatin had a 3-year survival rate quadruple that of patients who received pemetrexed and cisplatin alone.

Dr. Assuntina SaccoReviewed by:Assuntina Sacco, MD

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

  • Board-Certified Oncologist
  • Associate Professor at UC San Diego
  • Published Medical Author
Jenna TozziWritten by:

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Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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