* Mesothelioma Chemotherapy

    Chemotherapy is recognized as one of the few treatment options that can be effective for mesothelioma patients. Depending on the severity of the cancer, chemotherapy can alleviate symptoms, improve quality of life and prolong survival. For patients who are not candidates for surgery and are diagnosed with Stage 3 or 4 mesothelioma, the major treatment decision is often whether or not to undergo chemotherapy.

    The primary objective of chemotherapy is to kill cancerous cells. The most common combination of chemotherapy drugs for pleural mesothelioma treatment is Alimta(pemetrexed) plus cisplatin. Approved by the Food and Drug Administration in 2005, Alimta is the only chemotherapy medication approved specifically for the treatment of mesothelioma.

    In a 2003 Phase III clinical trial testing the combination of pemetrexed and cisplatin versus the single use of cisplatin, 448 mesothelioma patients received chemotherapy. A total of 226 patients received pemetrexed and cisplatin while 222 received cisplatin alone. The results demonstrated that the combination of pemetrexed and cisplatin was more effective in terms of survival (12.1 months vs. 9.3 months), median time to progressive disease (5.7 months vs. 3.9 months) and response rate (41 percent vs. 17 percent).

and Combination Chemotherapy

    The efficacy of single agent chemotherapy for mesothelioma treatment has been studied for many years. This type of chemotherapy uses a single medication to treat cancer. Over the course of many clinical trials, patient response rates to single agents have typically been very low, ranging from zero percent to 15 percent in most cases. In unique cases, sometimes involving high doses of a medication, response rates have increased. Chemotherapy drugs that have been used as single agents for mesothelioma treatment include cisplatin, carboplatin and doxorubicin.

    Combination chemotherapy involves the use of two or more anticancer medications. Recent studies have shown positive results in mesothelioma patients undergoing this type of chemotherapy. As mentioned previously, the combination of cisplatin and pemetrexed can be an effective treatment option for mesothelioma patients. Other chemotherapy combinations that have been applied to the treatment of mesothelioma include cisplatin and doxorubicin, cisplatin and mitomycin, and cisplatin with gemcitabine. Triple-drug combinations have not demonstrated better results than two-drug combinations.

Chemotherapy for Peritoneal Mesothelioma Patients

    The most effective chemotherapy regimen for peritoneal mesothelioma patients is unclear due to the smaller amount of trials conducted for this type of mesothelioma. However, because peritoneal mesothelioma patients are not often candidates for surgery due to the extent of the cancer, chemotherapy may be a valuable treatment option.

    Intraperitoneal chemotherapy may provide positive results for patients wishing to combat the disease. In one of the largest studies of intraperitoneal chemotherapy, Markman et al. evaluated 19 patients using a combination of cisplatin and mitomycin. Of the 15 patients with malignant ascites (excess fluid in the space between the tissues lining the abdomen and abdominal organs), seven (47 percent) experienced control of fluid accumulation between two and 73 months. A total of four patients survived more than three years.

    Intraperitoneal chemotherapy inserts a high drug concentration directly into the peritoneal cavity, but poor penetration into tumors. Studies of intraperitoneal drug delivery have shown that direct tumor absorption occurs at a level of only a few millimeters from the surface. As a result, hyperthermic intraperitoneal chemotherapy (HIPEC) may be an option for peritoneal mesothelioma patients willing to try treatments still in the development process.

    Before HIPEC (also known as heated chemotherapy), patients undergo surgery to remove as many tumors as possible. During HIPEC, patients are treated with a heated chemotherapy solution that is circulated throughout the abdominal cavity. The high temperature of the solution increases the effectiveness of the medication. Heated chemotherapy can prolong survival and reduce pain.

First Line vs. Second Line Chemotherapy

    First line chemotherapy offers the most favorable approach to treating cancer. First line chemotherapy for pleural mesothelioma patients is typically a combination of cisplatin and pemetrexed, although other medications may be used depending on a number of factors. If first line chemotherapy fails to treat the cancer or demonstrate positive results, second line chemotherapy may be prescribed. This type of chemotherapy may involve a similar approach to the initial treatment or a completely different combination of medications.

Benefits of Chemotherapy

    Clinical trials have revealed positive results for mesothelioma patients who undergo chemotherapy. Many of these studies have reported a survival advantage for the combination of cisplatin with other chemotherapy drugs. More importantly, clinical trials testing the effects and response rates of chemotherapy are gradually increasing the knowledge of specialists that study mesothelioma treatment.

    Although chemotherapy is often used in conjunction with other treatments such as surgery and radiation therapy, chemotherapy can act as a first line treatment option for mesothelioma patients who are not candidates for surgery. Before considering chemotherapy as a treatment option for mesothelioma, become familiar with the sides effects typically associated with the treatment.

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