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Mesothelioma

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Chemotherapy for mesothelioma

Chemotherapy is one of the main treatments for mesothelioma. Many people are not diagnosed until their mesothelioma is advanced and cannot be removed with surgery. In these cases, chemotherapy is used to treat the disease and relieve symptoms.

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to treat cancer. It is usually a systemic therapysystemic therapyTreatment that travels through the bloodstream to reach cells all over the body. that circulates throughout the body and destroys cancer cells, including those that may have broken away from the primary tumour. Chemotherapy may also be a regional therapy given to specific areas of the body. Regional chemotherapy for mesothelioma may be given directly into a body cavity (intracavitary chemotherapy) that contains cancer including the:

  • chest cavity (intrapleural chemotherapy)
  • abdominal cavity (intraperitoneal chemotherapy)

Chemotherapy may be used:

  • as the main treatment to shrink the tumour and keep the cancer under control
    • Chemotherapy may be used in this way for people:
      • who cannot have surgery because their cancer is considered inoperable (unresectable)
      • with sarcomatoid subtype of mesothelioma
      • not well enough to tolerate surgery
      • who decide not to have surgery
  • to relieve pain or to control the symptoms of advanced mesothelioma (palliative chemotherapy)
  • after surgery to destroy cancer cells left behind and to reduce the risk of the cancer recurring (adjuvantadjuvantTreatment given in addition to the first-line therapy (the first or standard treatment) to help reduce the risk of a disease (such as cancer) coming back (recurring). chemotherapy)
  • before surgery to shrink a tumour (neoadjuvantneoadjuvantTreatment given to shrink a tumour before the first-line therapy (the first or standard treatment), which is usually surgery. chemotherapy)

Drugs, doses and schedules vary from person to person.

Chemotherapy drugs

The most common chemotherapy drugs used to treat mesothelioma are:

  • cisplatin (Platinol AQ)
  • carboplatin (Paraplatin, Paraplatin AQ)
  • an antifolate drug
    • pemetrexed (Alimta)
    • raltitrexed (Tomudex)
  • gemcitabine (Gemzar)
    • Gemcitabine may be given to people who cannot have platinum-based (cisplatin or carboplatin) combination chemotherapy.
  • vinorelbine (Navelbine)
    • This drug may be also given to people who cannot have platinum-based combination chemotherapy or who have been treated previously with platinum-based combination chemotherapy.

Although a single drug may be used, better responses to chemotherapy occur when a combination of drugs are given for mesothelioma. The most common chemotherapy combinations used to treat mesothelioma are:

  • cisplatin and an antifolate drug
    • cisplatin and pemetrexed – most common combination used
    • cisplatin and raltitrexed
  • carboplatin (Paraplatin, Paraplatin AQ) and an antifolate drug
    • Carboplatin may be used instead of cisplatin, especially in older adults because it causes less kidney and nerve problems than cisplatin.
    • Drug combinations may include:
      • carboplatin and pemetrexed
      • carboplatin and raltitrexed
  • cisplatin and gemcitabine
  • carboplatin and gemcitabine

These combinations of drugs are given intravenously for 3–6 cycles. In some cases, they are given until the disease progresses.

Regional chemotherapy

Regional (intracavitary) chemotherapy for mesothelioma may include:

  • intrapleural chemotherapy
    • Chemotherapy drugs are injected through a chest tube or catheter into the pleural cavity (the space between the membranes lining the lung and chest wall).
    • It is used to treat pleural mesothelioma.
    • Intrapleural chemotherapy can be used to control pleural effusions.
  • intraperitoneal chemotherapy
    • Chemotherapy drugs are injected into the peritoneal space or peritoneal cavity (space between the abdominal organs and the membrane lining the abdominal wall).
    • This is the way chemotherapy is most often given to treat peritoneal mesothelioma. Peritoneal mesothelioma usually remains confined to the peritoneal cavity until late in the course of the disease. Giving drugs directly into the peritoneal cavity greatly enhances the concentration of drugs in that area and limiting side effects to the rest of the body.

Sometimes regional chemotherapy is given right after surgery (in the operating room) or soon afterwards.

Some of the drugs used as regional chemotherapy to treat mesothelioma include:

  • cisplatin
  • mitomycin (Mutamycin)
  • doxorubicin (Adriamycin)

Regional chemotherapy drugs are sometimes heated before they are given (hyperthermic chemotherapy) to help them work better.

For more detailed information on specific drugs, go to sources of drug information.

See a list of questions to ask your doctor about chemotherapy.

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