Chemotherapy Medications Overview
As one of three primary treatment options for mesothelioma patients (including surgery and radiation), chemotherapy is an important method of combating cancer and preventing short-term mesothelioma recurrence. Though it’s not a cure, chemotherapy drugs for mesothelioma can help slow mesothelioma spread by killing cancer cells and stopping them from multiplying.
Different chemotherapy medications have been developed and tested for their ability to treat mesothelioma.
If you’ve been prescribed chemotherapy for mesothelioma, here is what you need to know about these anti-cancer medications:
- Chemotherapy drugs are divided by first-line and second-line medications
- First-line chemotherapy drugs are combinations that have proven to be most effective
- Second-line chemotherapy drugs are introduced when the patient stops responding to initial medications
- The standard mesothelioma chemotherapy drug combination is Alimta (pemetrexed) and cisplatin
- Chemotherapy drugs are often combined for “synergistic” effects—meaning their individual effects are optimized when combined
Clinical trials are currently testing different chemotherapy drug combinations and approaches for mesothelioma to find new and better ways of fighting this disease and ultimately preventing recurrence.
Types of Chemotherapy Medications for Mesothelioma
There are several types of chemotherapy drugs, each with their own chemical composition and formula designed to operate on cancer cells. Traditional chemotherapy drugs are anti-cancer medications that actually kill cancer cells either by destroying them or damaging their DNA.
The effectiveness of chemotherapy drugs varies from patient to patient, which is why researchers continue to develop different types of medications—to offer a greater number of patients more options for anti-cancer treatment.
As of now, there are six main chemotherapy drugs used to treat mesothelioma either on their own or in a combination of two or more. Only a few of these drugs—one being a combination—are actually FDA-approved as a mesothelioma treatment.
The six primary and most promising mesothelioma chemotherapy drugs are:
- Alimta (pemetrexed)
It’s important to note that while the FDA has not yet approved several of these drugs for mesothelioma, other countries around the world have approved them and continue to uphold their status as approved drugs. US patients have access to these drugs in clinical trial settings.
The first FDA-approved drug for mesothelioma, Alimta (generic name, pemetrexed) is an antimetabolite drug, meaning it blocks the enzymes that are responsible DNA synthesis in mesothelioma cells. In short, Alimta prevents the mesothelioma cells from knowing to replicate themselves, which causes them to die off.
Alimta is approved as a standard first-line chemotherapy drug for mesothelioma used in combination with cisplatin (see below)—another chemotherapy drug. Alimta and cisplatin are widely regarded as having the best overall survival results for pleural mesothelioma patients.
Carboplatin (brand name, Paraplatin) is an alkylating chemotherapy agent, meaning it acts directly on the mesothelioma cell’s DNA, preventing it from dividing itself into two cells. Carboplatin is generally considered to have less toxic effects, meaning it results in fewer side effects for patients.
Because it is more tolerable, carboplatin is often administered in second-line chemotherapy treatment after mesothelioma patients have stopped responding to or cannot tolerate the effects of stronger, first-line drugs.
Carboplatin is FDA-approved for other types of cancer like ovarian and breast, but not FDA-approved for mesothelioma. Carboplatin is still offered to patients as a mesothelioma treatment such as through clinical trials. It has only shown effectiveness as an intraperitoneal chemotherapy drug used in HIPEC (heated intraperitoneal chemotherapy), which is administered directly into the abdominal cavity during surgery.
Cisplatin (brand name, Platinol) is one of the most commonly used chemotherapy therapy drugs for mesothelioma. As an alkylating agent, cisplatin targets mesothelioma cells and destroys them as they are in the process of dividing—known as the resting phase of the life cycle.
Cisplatin is one of a handful of platinum-based chemotherapy drugs designed to use platinum to attach to cancer cells’ DNA strands to force them into apoptosis (when cells die off). Cisplatin on its own isn’t incredibly effective at treating mesothelioma, though it can be in certain patients.
That’s why cisplatin is often combined with other chemotherapy drugs such as Alimta. Combining cisplatin with another non-platinum-based drug creates a synergistic effect, whereby there are multiple, optimized approaches to killing off mesothelioma cells in one stacked prescription. Cisplatin is also being tested in combination with gemcitabine and is showing promising results.
Gemcitabine (brand name, Gemzar) is an FDA-approved chemotherapy medication developed to treat breast, ovarian, pancreatic and non-small cell lung cancers. It’s currently being tested as a mesothelioma chemotherapy medication for its synergistic effects when combined with cisplatin. However, it can also be given to mesothelioma patients on its own as an alternative to Alimta or cisplatin for patients who aren’t responding well to these two drugs.
Gemcitabine is an antimetabolite drug, meaning it interferes with the cancer cell’s metabolic process at a very specific phase of its life cycle and prevents it from replicating. Gemcitabine has so far shown promising results in pleural mesothelioma patients and may be beneficial for pericardial mesothelioma.
Navelbine (generic name, vinorelbine) is an FDA-approved drug developed to treat breast cancer, non-small cell lung cancers, and pleural mesothelioma. Navelbine is classified as a vinca alkaloid—a semi-synthetic chemotherapy drug partially derived from the vinca genus of plants, also known as periwinkle.
Vinca alkaloids like Navelbine inhibit the formation of proteins that are necessary for mesothelioma cells to divide and replicate themselves. By preventing cells from using this protein, Navelbine causes the mesothelioma to die off because they can’t divide.
A current clinical trial is determining whether Navelbine is effective in treating pleural mesothelioma patients who have certain genetic markers, and if so, whether it can help them live longer.
Onconase (generic name, ranpirnase) is a mesothelioma chemotherapy drug currently being tested and is not yet FDA-approved. Onconase is an enzyme-based chemotherapy drug that targets mesothelioma cells and interferes with their ability to replicate. Onconase is different from other traditional chemotherapy drugs because it attaches itself to cancer cell receptors, which ultimately spares healthy cells.
Onconase is still undergoing clinical trials to test its effectiveness in treating mesothelioma. It’s believed to be a possibly viable second-line chemotherapy drug for patients who have already undergone chemotherapy and have experienced recurrence.
Combinations of Chemotherapy Medications for Mesothelioma
Medical oncologists (chemotherapy doctors) have discovered certain drug combinations that have proven to be most effective in treating mesothelioma. With years of ongoing research, mesothelioma scientists have made significant progress in developing chemotherapy approaches that can help improve patient survival rates.
Currently, chemotherapy for mesothelioma is divided into standard first-line and second-line treatment approaches and combinations.
First-Line Chemotherapy Medications for Mesothelioma
First-line chemotherapy refers to a treatment approach that is considered most effective in treating mesothelioma. For pleural mesothelioma, first-line chemotherapy drugs include a combination of Alimta (pemetrexed) and cisplatin. Studies continue to show that pemetrexed/cisplatin combination is the best solution for late-stage pleural mesothelioma patients.
In some cases, doctors may prescribe one of the two drugs when patients aren’t healthy enough to undergo the harsh chemical effects of two potent drugs. However, single-drug approaches are not nearly as effective in slowing disease progression as combinations are.
Second-Line Chemotherapy Medications for Mesothelioma
Second-line chemotherapy refers to the approach doctors take when patients stop responding to first-line standard drug combinations. Patients may either show no signs of improvement from first-line drugs, or they may develop such severe side effects that they can no longer continue on the original drug plan.
Second-line chemotherapy offers a renewed hope for many patients, as it provides them with additional options for slowing disease progression and potentially extending survival time. Doctors may prescribe carboplatin as an alternative to cisplatin, or introduce a new drug such as gemcitabine. Doctors may also recommend that patients participate in clinical trials for other drugs like onconase of Navelbine.
Participating in Mesothelioma Chemotherapy Clinical Trials
Clinical trials across the country are currently underway, testing out new chemotherapy drug combinations as well as entirely new drugs for mesothelioma patients. You may be eligible to participate in certain clinical trials currently recruiting mesothelioma patients. Some clinical trials are limited to certain disease forms or even genetic traits, but many are open to late-stage patients or patients who have stopped responding to other treatments.
Clinical trials are incredibly important for the future of mesothelioma research. The results that are monitored during testing help doctors determine not only which mesothelioma chemotherapy drugs are most effective, but which types of patients they are most effective for.
For more information on participating in clinical trials for new and novel chemotherapy drugs contact Mesothelioma Hope today and speak to one of our Medical Experts. We can help connect you with cancer centers across the country that are currently recruiting mesothelioma patients.