Chemotherapy for mesothelioma

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage health cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy. Sometimes chemotherapy is used as a regional therapy for a specific area of the body. For peritoneal mesothelioma, chemotherapy may be given into the peritoneal cavity.

Most people with mesothelioma have chemotherapy. If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules of chemotherapy.

Chemotherapy may be the only treatment you have or it may be used along with other cancer treatments. You may have chemotherapy to:

• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (called adjuvant chemotherapy)
• relieve pain or control the symptoms of advanced mesothelioma (called palliative chemotherapy)
• shrink tumours before surgery (called neoadjuvant chemotherapy)

The most common chemotherapy drugs used for pleural mesothelioma are:

• pemetrexed
• vinorelbine

The most common chemotherapy drug combinations used for pleural mesothelioma are:

• cisplatin and pemetrexed
• cisplatin and raltitrexed
• pemetrexed and carboplatin
• cisplatin and gemcitabine

If pleural mesothelioma doesn’t respond to drugs used in earlier treatments or if it comes back after treatment, the following drugs may be used:

• pemetrexed (if not used before)
• vinorelbine
• gemcitabine

Before you have chemotherapy with pemetrexed, your healthcare team will give you vitamin B12 and folic acid supplements. These can help reduce some of the side effects of this drug.

Chemotherapy for peritoneal mesothelioma is given as a regional therapy, which means that it is given directly into the peritoneal cavity. This is called intraperitoneal chemotherapy. When the drugs are heated before they are put into the body, it is called hyperthermic intraperitoneal chemotherapy.

After surgery to remove as much of the cancer as possible from the abdomen (called debulking surgery), the chemotherapy drugs are put directly into the peritoneal cavity through a cut (incision) in the abdomen. The surgeon moves the drugs around the cavity by hand so that they come into contact with and treat all of the surfaces that may have cancer cells on them. Then the surgeon closes the cut. The chemotherapy drugs are left in the abdomen and the body slowly absorbs them.

If surgery isn’t possible, then chemotherapy is given into the abdomen through a thin tube (catheter). The surgeon places a special pump just under the skin. The tube is attached to the pump. One end of the tube is put inside the peritoneal cavity and the other end is left outside of the body. Chemotherapy drugs are put into the peritoneal cavity through the tube. You will be told to change positions a number of times to make sure that the chemotherapy drugs come into contact with all of the organs in the peritoneal cavity. The drugs are eventually absorbed by your body.

The most common chemotherapy drugs used for intraperitoneal chemotherapy are:

• cisplatin
• mitomycin
• doxorubicin

Sometimes cisplatin is combined with either mitomycin or doxorubicin.

Intraperitoneal chemotherapy may be done again if peritoneal mesothelioma comes back (recurs) after treatment.

Side effects of chemotherapy will depend mainly on the drug, the dose, how it’s given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Some common side effects of chemotherapy drugs used for mesothelioma are:

• low blood cell counts
• fatigue
• nausea and vomiting
• diarrhea
• nerve damage
• abdominal pain
• sore mouth and throat
• skin rash
• loss of appetite

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.