Chemotherapy Medications

For patients diagnosed with mesothelioma, chemotherapy may play a large role in treatment options, whether given by itself or as part of a comprehensive treatment plan involving surgery and/or radiation.

Chemotherapy Medications Overview

Mesothelioma patients can receive chemotherapy by itself, or in combination with surgery, radiation, or other cancer drugs.

Chemotherapy introduces anti-cancer drugs into the bloodstream in cycles followed by periods of rest to allow the body time to recover. Each drug has a specific frequency regarding how often it has to be administered. Generally, each cycle lasts about three to four weeks.

Chemotherapy is recommended for patients with good overall health for which it would be reasonably safe to administer, and also based on the extent of the cancer.

For patients able to undergo surgery, chemotherapy may be given before or after the procedure based on factors such as mesothelioma cell type and specialist recommendation.

For patients unable to undergo surgery, chemotherapy may slow mesothelioma cell growth or shrink the tumor but in most cases, complete disappearance of these cancer cells is very unlikely.

It’s important to keep a written list of all over-the-counter medicine, prescription medication, and vitamins or supplements you’re taking during chemotherapy. Have this list with you in case of emergencies, as well as to all doctor and hospital visits.

Side effects of chemotherapy will vary based on the drug used for treatments, how it’s given, what dose is applied, and overall health.

Common side effects may include:

  • Fatigue
  • Loss of appetite
  • Sore mouth and throat
  • Abdominal pain
  • Nausea or vomiting
  • Diarrhea
  • Low blood counts
  • Skin rash
  • Nervous system damage

Talk to your doctor if you or a loved one experiences these or other side effects from mesothelioma treatment. The sooner side effects are mentioned, the faster medical professionals can help deal with and potentially alleviate these symptoms.

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Types of Chemotherapy Drugs for Mesothelioma

Chemotherapy drugs are anti-cancer drugs that work separately or in combination with each other and other types of cancer treatments to eliminate cancer, control cancer, or relieve its symptoms.

Alimta

Alimta, otherwise known as pemetrexed disodium, is an FDA-approved medication that works to block the actions of substances in the body that encourage cancer cell multiplication.

While on Alimta, it’s important to keep all appointments with labs and doctors to check and maintain the body’s response to all medicines currently being used.

Several Alimta clinical studies are available if current treatment is not recommended by doctors. Before looking into clinical trials, make sure to consult with your doctor to verify you qualify.

Studies being conducted include research on discovering the different treatment effects of Alimta for use with other medications, radiation therapy, maintenance therapy, surgery, and other techniques.

Typical results of using Alimta with other medications or in tandem with other treatment options have been positive.

When comparing Alimta alone versus in use with other medicinal treatments like Cisplatin (see below), results increase greatly, and growth rates of tumors decrease significantly.

Cisplatin

FDA-approved Cisplatin forms charged, highly reactive, platinum complexes in the body that bind to nucleophilic groups in DNA.

The reaction of Cisplatin works in cross-links (a chemical bond between chains of atoms in the body) to help stop the growth of cancerous cells or encourage the death of these cancerous cells.

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Gemcitabine

An antimetabolite, Gemcitabine is an FDA-approved drug that is injected into the vein weekly for the length of treatment as prescribed by doctors.

It enters the body resembling a normal cell nutrient that cancer cells require to keep growing. As a look-alike, it is “ingested” by the cancer cells and interferes with their growth.

Several clinical trials are being conducted on the effects and usage of Gemcitabine alone and with other treatment options.

Carboplatin

Carboplatin is a chemotherapy drug that interferes with the development of the genetic material in the DNA and cells, which stops the cancer from dividing into two new cells before causing them to die.

FDA-approved, it is given intravenously, and both the dose and schedule given will be tailored to each individual’s needs. Some treatments may be given directly into the peritoneal cavity in the abdomen.

Bevacizumab

Bevacizumab, otherwise known as Avastin, is an FDA-approved antibody that targets and blocks the growth of blood vessels that the cancer needs to receive nutrients to grow.

Bevacizumab is typically given in combination with other chemotherapy drugs.

Onconase

Undergoing clinical trial testing, Onconase is relatively new, and studies are working to determine its level of effectiveness in treating mesothelioma.

Onconase inhibits cellular growth, speeding up the breakdown of ribonucleic acid (RNA), and initiating death in cancerous cells. It also enhances the anti-cancer effect of traditional treatments for mesothelioma chemotherapy.

Though Onconase is one of many new chemotherapy drug options in clinical testing, initial clinical studies may suggest it could be a better treatment option than traditional chemotherapy drugs. This is because it produces few of the side effects commonly experienced during chemotherapy.

Onconase currently holds an orphan drug status by the FDA, which means that it is intended to treat diseases so rare that pharmaceutical companies are not likely to develop them under unusual market conditions or limited potential for profitability.

Navelbine

Mainly used in clinical trials to date, Navelbine (Vinorelbine) is an FDA-approved anti-cancer drug that works by interfering with genes and stops the cells from reproducing.

Several clinical trials are being conducted on the effects and usage of Navelbine alone and with other treatment options.

First-Line vs Second-Line Chemotherapy Drugs

First-line therapy (also called primary treatment/therapy) is the accepted practice approved by the medical establishment as the most effective treatment for certain types of cancer.

The focus of first-line therapy is often to cure the mesothelioma if possible, which means eliminating as many cancer cells as possible. This treatment is the first assault of chemotherapy drugs on the tumor.

First-line therapies may show progress for a period of time but then stall or fail to halt the growth of cancerous cells.

Other problems with first-line therapies could include:

  • Unacceptable side effects
  • Damaged organs
  • Life-threatening symptoms
  • Limited effectiveness

Regular evaluations (physical exams and scans) will be completed to determine if the first-line therapies are working. If these treatments fail, they will be stopped and a new course of treatment will be recommended.

Some mesothelioma specialists may use second-line treatments as a first-line treatment option despite being labeled as secondary. It is worth noting that this may present problems with insurance companies when used directly as a first-line option.

These second-line treatments use drugs that have also been shown to be effective, but perhaps not as effective as first-line treatments. As more clinical trials are carried out to test and compare the effectiveness of new or existing treatments, medical standards could ultimately change.

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Current Drugs/Combinations Being Tested in Clinical Trials

Clinical trials are routinely being conducted to improve upon existing treatments, test new drugs or combinations of treatments, and ways to make the drugs easier and more convenient to take (for example, taking an oral pill rather than intravenously).

Research currently being conducted in chemotherapy includes:

  • Finding ways to overcome drug resistance by testing combinations of drugs
  • Improving doses and schedules
  • Nanotechnology to deliver chemotherapy
  • Combining radiation therapy and chemotherapy

Any drug included in the chemotherapy process can interact with other medicines or herbal products. Make sure to tell your medical professionals about any medicines, herbal supplements, over the counter remedies, or vitamins you are currently taking.
The drugs listed above are in clinical trials by themselves, in combination with other drugs, or in combination with other therapies and treatments.

Immunotherapy, a newer class of cancer treatments that helps the body’s immune system fight cancer smarter, is also being actively studied in patients with mesothelioma.

These treatments, including nivolumab (Opdivo), ipilimumab (Yervoy), and pembrolizumab (Keytruda), have shown promising benefits when given alone or in combination to patients with mesothelioma.

They continue to be evaluated in clinical trials but are currently recommended for patients whose cancer is no longer responding to chemotherapy.

Contact our Patient Advocates today for more information on getting your chemotherapy medication costs covered through legal compensation options for mesothelioma patients.

Reviewed by:Dr. Assuntina Sacco

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.

Mesothelioma Hope was founded by a team of advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. We help give hope to those impacted by mesothelioma.

15 references
  1. American Cancer Society, “Chemotherapy for Malignant Mesothelioma” Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/chemotherapy.html. Accessed on January 9, 2018.
  2. Cancer Research UK, “Pemetrexed and cisplatin” Retrieved from: http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/pemetrexed-cisplatin. Accessed on January 9, 2018.
  3. Forbes, “Why is platinum in some chemotherapy drugs, and can we improve them?” Retrieved from: https://www.forbes.com/sites/carmendrahl/2017/04/14/why-is-platinum-in-some-chemotherapy-drugs-and-can-we-improve-them/2/#4884d0843d52. Accessed on January 9, 2018.
  4. BC Cancer Society, “Carboplatin”. Retrieved  from: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Carboplatin_monograph_1Jan2014.pdf. Accessed on January 9, 2018.
  5. Cancer Research UK, “Vinorelbine (Navelbine)” Retrieved from: http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/vinorelbine. Accessed on January 9, 2018.
  6. US National Library of Medicine, “Vinorelbine in Mesothelioma” Retrieved from: https://clinicaltrials.gov/ct2/show/NCT02139904. Accessed on January 9, 2018.
  7. National Cancer Institute, “Pemetrexed Disodium.” Retrieved from: https://www.cancer.gov/about-cancer/mesothelioma-treatment/drugs/pemetrexeddisodium Accessed February 8, 2018.
  8. Medline Plus, “Pemetrexed Injection.” Retrieved from: https://medlineplus.gov/druginfo/meds/a607043.html Accessed February 9, 2018.
  9. Medline Plus, “Cisplatin Injection.” Retrieved from: https://medlineplus.gov/druginfo/meds/a684036.html Accessed February 9, 2018.
  10. The Oncologist, “Pemetrexed Disodium: A Novel Antifolate Clinically Active Against Multiple Solid Tumors.” Retrieved from: http://theoncologist.alphamedpress.org/content/6/4/363.full#sec-2 Accessed February 12, 2018.
  11. National Cancer Institute, “Cisplatin.” Retrieved from: https://www.cancer.gov/about-cancer/mesothelioma-treatment/drugs/cisplatin Accessed February 15, 2018.
  12. Chemoth.com, “Explanation of First-Line and Second-Line Chemotherapy Regimens.” Retrieved from: http://chemoth.com/firstline Accessed February 14, 2018.
  13. Cancer Treatment Centers of America “Gemcitabine.” Retrieved from: https://www.cancercenter.com/cancer-drugs/gemcitabine/ Accessed February 15, 2018.
  14. National Cancer Institute, “Gemcitabine-Cisplatin.” Retrieved from: https://www.cancer.gov/about-cancer/mesothelioma-treatment/drugs/GEMCITABINE-CISPLATIN Accessed February 15, 2018.
  15. ChemoCare, “Navalbine.” Retrieved from: http://chemocare.com/chemotherapy/drug-info/Navelbine.aspx Accessed February 17, 2018.

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