Mesothelioma Chemotherapy Medications

Doctors treat most mesothelioma patients with chemotherapy, typically consisting of a combination of two drugs for maximum effectiveness. These chemotherapy medications can be used alone or after other treatments. The best chemotherapy drugs have successfully extended patients’ survival times and improved their quality of life.

Fact-Checked and Medically Reviewed By: Dr. Assuntina Sacco

What Are Mesothelioma Chemotherapy Medications?

Mesothelioma chemotherapy is treatment using anti-cancer drugs administered orally or by intravenous (IV) means. These drugs are usually given as a drip into the bloodstream in cycles followed by periods of rest to allow the body time to recover. Each drug has a specific frequency for how often it should be given. Generally, each “cycle” of treatment lasts about 3-4 weeks.

Chemotherapy

For patients who undergo mesothelioma surgery, chemotherapy treatment may be given before or after the procedure. Neoadjuvant therapy refers to chemo before surgery, while adjuvant therapy is chemo after surgery.

According to the American Cancer Society, mesothelioma chemotherapy medications are most effective when combined with surgery.

Doctors measure the success of chemotherapy drugs by key objectives such as:

  • Reduction of new cancerous cell growth
  • Decreasing the size of existing tumors

Chemotherapy for mesothelioma is unlikely to kill all existing cancer cells and therefore is used primarily to keep the disease from progressing. And while most mesothelioma patients are diagnosed at an older age, what matters most is their general health and whether they can withstand the powerful drugs.

“Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting it.”

– The American Cancer Society

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Types of Mesothelioma Chemotherapy Drugs

Chemo drugs are anti-cancer drugs that work separately or in combination with each other and other cancer treatments to eliminate cancer, restrict cancer growth, or relieve its symptoms.

Doctors routinely use these chemotherapy medications to treat mesothelioma.

Alimta (pemetrexed)

The U.S. Food and Drug Administration (FDA) approved Alimta (pemetrexed) in 2004 to treat pleural mesothelioma in combination with another chemotherapy medication called cisplatin.

Alimta works by blocking cancer cells from making and repairing DNA, which stops the cells from multiplying and growing.

Currently, Alimta coupled with cisplatin is the most common combination of chemo medications used to treat malignant pleural mesothelioma patients and the most effective mesothelioma treatment for patients who are not eligible for surgery. Because Alimta lowers folic acid and B12 levels, doctors prescribe supplements.

Carboplatin

Carboplatin is an FDA-approved platinum-based chemotherapy drug known as an alkylating agent that is most active when cancerous cells are resting. It interferes with cancer cells’ DNA and stops them from multiplying.

Cisplatin

Like carboplatin, cisplatin is a platinum-based chemo drug and an alkylating agent.

Did You Know?

The FDA approved cisplatin in 1978, and oncologists have been using it to treat a wide range of cancers ever since.

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Cisplatin is often heated and used with doxorubicin to treat malignant peritoneal mesothelioma patients undergoing a two-part cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).

Gemcitabine (Gemzar)

Gemcitabine is an FDA-approved chemotherapy medication sold under the brand name Gemzar. It is a type of anticancer medication known as an antimetabolite.

Antimetabolites are similar to normal cell substances. As a result, antimetabolites trick cancer cells into incorporating them into their cellular metabolism. This interferes with the cancer cell’s ability to divide.

Gemcitabine is usually combined with other chemotherapy drugs and is often prescribed because it is milder than other chemotherapy medications.

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

Onconase

Onconase is a relatively new chemotherapy medication being tested in clinical studies to determine its effectiveness in treating mesothelioma. It is a protein derived from the early embryos of northern leopard frogs.

Onconase breaks down a type of genetic material known as RNA and leads to the death of cancer cells. It also enhances the anticancer effects of traditional mesothelioma chemotherapy medications.

Mesothelioma researchers are optimistic about Onconase because it produces few harsh side effects commonly experienced during chemotherapy.

Navelbine (vinorelbine)

Navelbine (vinorelbine) is a plant-based anticancer drug that interferes with genes and stops cancer cells from reproducing.

The FDA approved Navelbine in 1994 to treat non-small cell lung cancer.

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

Navelbine is mostly considered palliative care or maintenance treatment for mesothelioma patients as there is evidence that it can relieve pain without shrinking tumor mass.

Navelbine is sometimes paired with the chemotherapy medications Adriamycin (doxorubicin) and oxaliplatin. Researchers are also studying Navelbine to fight other types of cancer.

How Are Mesothelioma Chemotherapy Medications Given?

Mesothelioma chemotherapy medications are typically given in one of two ways:

  1. Systemic chemotherapy: Chemotherapy medication is given through an intravenous (IV) injection into the bloodstream, which allows the drug to spread throughout the body to kill cancer cells.
  2. Intraoperative chemotherapy: During a surgical procedure, chemotherapy medication is applied into the body directly where the cancer is located, either in the chest or abdominal cavity, and sometimes heated to help the drug work better. It is used following two mesothelioma surgical procedures — cytoreductive surgery and pleurectomy with decortication (P/D).

Mesothelioma specialists commonly use these drugs for heated chemotherapy (HIPEC):

  • Cisplatin with doxorubicin (most common)
  • Paclitaxel (Taxol)
  • Pemetrexed (Alimta)

First-Line vs Second-Line Chemotherapy Medications

First-line chemotherapy (also called primary treatment/therapy) is the accepted practice approved by the medical community as the most effective way to treat cancer.

Chemotherapy - doctor changing dosage.

First-line chemotherapy aims to cure the mesothelioma patient by eliminating as many cancer cells as possible. This treatment is the first assault on the tumorous mass.

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

Mesothelioma patients undergo regular testing to determine if the first-line therapies are working. If these treatments fail, they will be stopped, and a new treatment will be recommended.

One way to think of first-line vs second-line is with a sports analogy. Picture the first-line medications as the “starting lineup.” The second line is like the reserves that come in when the star players need a rest or are not playing well.

Second-line treatments use drugs that have been effective but perhaps not as effective as first-line treatments. As more mesothelioma clinical trials are conducted to test and compare the effectiveness of new or existing treatments, medical standards could ultimately change.

Some mesothelioma doctors may use second-line treatments as a first-line treatment option depending on a patient’s specific case.

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Side Effects of Mesothelioma Chemotherapy Medications

The risk of standard chemo drugs is that they attack cancer cells and healthy cells, which can cause many side effects. The side effects that a mesothelioma patient experiences will vary based on the chemotherapy medication given and the patient’s general health.

Common side effects of chemotherapy medications include:

  • Bone marrow damage (leading to low blood cell counts)
  • Fatigue
  • Hair loss
  • Mouth sores
  • Nausea or vomiting
  • No appetite

Some chemo medications have specific side effects. For example, carboplatin and cisplatin can cause peripheral neuropathy (nerve damage that causes numbness in the hands and feet).

Patients who receive intrapleural or intraperitoneal chemotherapy medications usually have fewer side effects than patients who undergo systemic chemo.

Talk to your oncology team if you experience these or other side effects from mesothelioma treatment.

Clinical Trials for Mesothelioma Chemotherapy Medications

Mesothelioma clinical trials are routinely being conducted to improve upon existing treatments. These studies test new drugs and drug combinations and are creating new pathways in cancer research.

Research currently being conducted in the area of mesothelioma chemotherapy includes:

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

The drugs listed above are in clinical trials by themselves, in combination with other drugs, or in combination with other therapies and treatments such as hormone therapy and virotherapy.

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

A clinical trial called DREAM3R is investigating what happens when immunotherapy is combined with chemotherapy in untreated patients with unresectable (not able to be treated by surgery) pleural mesothelioma. As of December 2022, this Phase 3 clinical trial was actively enrolling patients in the United States and Australia.

Results from Phase 2 of the study showed that patients who received standard chemotherapy with added immunotherapy had an overall median survival rate of 20.4 months compared to 12.1 months achieved by patients in a prior Alimta-cisplatin study.

Additionally, the researchers noted that nearly 60% of the enrolled patients responded to the treatment and that only 4 out of 55 stopped treatment because of side effects.

Patients with epithelioid mesothelioma responded better than those with other cell types. Overall survival in the epithelioid group exceeded 2 years.

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Chemotherapy Medications FAQs

What chemo drugs are used for mesothelioma?

Several chemo drugs are used to treat mesothelioma, including:

  • Alimta (pemetrexed)
  • Carboplatin
  • Cisplatin
  • Gemcitabine (Gemzar)

Most mesothelioma chemotherapy medications are used in combinations of two. The most common pairing is Alimta and cisplatin.  

Is chemo effective against mesothelioma?

Chemotherapy is effective against mesothelioma in that it can slow the growth of cancer cells or shrink tumors.

This can increase patients’ survival times and alleviate their disease symptoms.

Unfortunately, chemo is unlikely to make mesothelioma cancer cells disappear.

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.

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

Lead Editor

Laura Wright is a journalist and content strategist with more than 14 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.

14 References
  1. American Cancer Society, “Chemotherapy for Malignant Mesothelioma” Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/chemotherapy.html. Accessed on December 23, 2022.

  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 December 23, 2022.

  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 December 23, 2022.

  4. BC Cancer Society, “Carboplatin.” Retrieved from: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Carboplatin_monograph_1Jan2014.pdf. Accessed on December 23, 2022

  5. Cancer Research UK, “Vinorelbine (Navelbine)” Retrieved from: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/vinorelbine-navelbine. Accessed on December 22, 2022.

  6. US National Library of Medicine, “Vinorelbine in Mesothelioma” Retrieved from: https://clinicaltrials.gov/ct2/show/NCT02139904. Accessed on December 22, 2022.

  7. National Cancer Institute, “Pemetrexed Disodium.” Retrieved from: https://www.cancer.gov/about-cancer/treatment/drugs/pemetrexeddisodium. Accessed on December 22, 2022.

  8. Medline Plus, “Pemetrexed Injection.” Retrieved from: https://medlineplus.gov/druginfo/meds/a607043.html Accessed on December 22, 2022.

  9. Medline Plus, “Cisplatin Injection.” Retrieved from: https://medlineplus.gov/druginfo/meds/a684036.html Accessed on December 22, 2022.

  10. National Cancer Institute, “Cisplatin.” Retrieved from: https://www.cancer.gov/about-cancer/mesothelioma-treatment/drugs/cisplatin. Accessed on December 22, 2022.

  11. National Cancer Institute, “Gemcitabine-Cisplatin.” Retrieved from: https://www.cancer.gov/about-cancer/treatment/drugs/gemcitabine-cisplatin. Accessed on December 22, 2022.

  12. ChemoCare, “Navalbine.” Retrieved from: http://chemocare.com/chemotherapy/drug-info/Navelbine.aspx. Accessed on December 22, 2022.

  13. Forde, P.M., Anagnostou, V., Sun, Z. et al. “Durvalumab with platinum-pemetrexed for unresectable pleural mesothelioma: survival, genomic and immunologic analyses from the phase 2 PrE0505 trial.” Nat Med 27, 1910–1920 (2021). Retrieved from: https://doi.org/10.1038/s41591-021-01541-0. Accessed on December 22, 2022.

  14. Mesothelioma Applied Research Foundation. “What happens when we combine chemotherapy with immunotherapy for mesothelioma?” Retrieved from: https://www.curemeso.org/2022/11/14/what-happens-when-we-combine-chemotherapy-with-immunotherapy-for-mesothelioma/. Accessed on December 22, 2022.

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