What Are Mesothelioma Chemotherapy Drugs?
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. Each “cycle” of treatment generally lasts about 3-4 weeks.
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. 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
Have you started, or are you getting ready to start chemotherapy treatment for mesothelioma? Our Free Mesothelioma Treatment Planner can help you stay organized with appointments and medication management so you can focus on your health.
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 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.
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 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.
The FDA approved cisplatin in 1978, and oncologists have used it to treat a wide range of cancers ever since.
Cisplatin is often heated and used with doxorubicin to treat malignant peritoneal mesothelioma patients undergoing 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:
- 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.
- 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 cancer treatment.
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.
Depending on a patient’s specific case, some mesothelioma doctors may use second-line treatments as a first-line option.
Need help finding mesothelioma treatments and doctors near you? Our free Mesothelioma Guide is a handy resource for all mesothelioma patients.
Side Effects of Mesothelioma Chemotherapy Medications
The risk of standard chemo drugs is that they attack cancer and healthy cells, which can cause 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 create 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 alone, in combination with other drugs, or 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 investigates what happens when immunotherapy is combined with chemotherapy in untreated patients with unresectable (unable to be treated by surgery) pleural mesothelioma. As of September 26, 2023, this Phase 3 clinical trial was still actively recruiting 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.
Need help knowing what to ask your doctor?
Download our Free Questions to Ask Your Doctor Checklist to arm you and your loved ones with 14 important questions every mesothelioma patient should ask their medical team.
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 symptoms. Unfortunately, chemo is unlikely to make mesothelioma cancer cells disappear entirely.
What's the first-line chemotherapy treatment for mesothelioma?
The first-line chemotherapy for pleural mesothelioma combines Alimta, approved in 2004, with cisplatin. The combination blocks cancer cells from multiplying by stopping DNA production and repair. This is the most commonly used medication combination for non-surgical patients. Doctors may also prescribe supplements to counteract the drug’s folic acid and B12 level-lowering effects.
