Chemotherapy for Peritoneal Mesothelioma

Quick Summary

Peritoneal mesothelioma presents a better prognosis than pleural mesothelioma—the life expectancy is longer for this disease location. However, even peritoneal mesothelioma has a relatively poor prognosis. Still, with the right combination of therapies, the prognosis can be dramatically improved.

Chemotherapy is one standard treatment for peritoneal mesothelioma. This form of therapy has many facets to it though, and exactly how it is administered depends on various patient-specific factors.

Chemotherapy continues to be a standard form of treatment for patients with peritoneal mesothelioma. With the advent of new, more effective forms of chemotherapeutic treatment such as HIPEC, peritoneal mesothelioma patients have more versatile treatment options than ever before. Although experts are making new, exciting advancements in chemotherapeutic treatment for mesothelioma, chemotherapy is still most effective when used in conjunction with other treatments. That being said, the treatment can have many benefits on its own.

What is Chemotherapy for Peritoneal Mesothelioma?

Chemotherapy is a treatment that utilizes chemotherapeutic agents which act to kill cancerous cells. Chemotherapy is one primary method of treatment for peritoneal mesothelioma. The cytotoxic agents (agents that are toxic to living cells) are administered directly to the peritoneal cavity in intraperitoneal chemotherapy.

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is also commonly used in the multimodal treatment of peritoneal mesothelioma.

This procedure is administered during surgery and has increased life expectancy for patients since its introduction. In fact, studies have shown that approximately 50% of patients who receive this specific type of multimodal therapy will live longer than five years.  With HIPEC, the chemotherapy drugs are combined with a saline wash and applied right to the site of the cancerous abdominal tissue.

It’s clear that HIPEC combined in multimodal therapy with cytoreductive surgery offers the best response in peritoneal mesothelioma patients. However, HIPEC with surgery is usually only a viable treatment option for patients with early-stage peritoneal mesothelioma.

Peritoneal mesothelioma patients who do not qualify for surgery have the anti-cancer drugs inserted into the abdominal cavity with a catheter. Outpatients also sometimes receive intravenous chemotherapy, where the drugs are introduced into the bloodstream with the intention of reducing the tumor size and prevent the mesothelioma from spreading. However, this method has so far been proven to be less effective than HIPEC, which is direct.

Benefits of Chemotherapy for Peritoneal Mesothelioma

Chemotherapy Benefits Update

While chemotherapy alone is not considered to be the most effective cancer treatment, chemotherapy offers several advantages over other therapies.

These advantages include:

  • That it can be incorporated into various treatment plans for diverse patients
  • That those with later stage mesothelioma can still qualify
  • As part of a multimodal treatment plan, chemotherapy can improve survival rates
  • It can provide palliative treatment and pain reduction

In other words, one of the most beneficial qualities of chemotherapy is its versatility. While certain patients may not be eligible for aggressive treatments such as invasive surgery, they can still receive chemotherapy to keep their mesothelioma at bay and improve their quality of life.

Chemotherapy can be molded into various treatment plans based on an individual’s needs, allowing doctors to recommend unique chemotherapy drugs and schedules for the diverse group of peritoneal mesothelioma patients.

In addition, chemotherapy is an excellent treatment option for early-stage peritoneal mesothelioma patients. These early-stage patients usually qualify for cytoreductive surgery with HIPEC. Receiving this treatment can greatly improve early-stage patients’ chances of living longer, while later stage patients can receive palliative benefits from this treatment. In either case, HIPEC represents the promise that new chemotherapeutic treatment methods hold. It shows that with ongoing research and trials, doctors can continue to increase the efficacy of chemotherapy and maximize its benefits for peritoneal mesothelioma even more.

Chemotherapy Schedule

Chemotherapy treatments follow a schedule in which courses of treatment are separated by periods of rest (usually 2 to 3 weeks). The exact schedule will depend on patient-specific factors, as well as the type of drugs that will be administered.

Some of the chemotherapy drugs that are used in the treatment of peritoneal mesothelioma are:

  • Pemetrexed (Alimta)
  • Gemcitabine
  • Irinotecan
  • Cyclophosphamide
  • Doxorubicin
  • Platins, such as cisplatin and carboplatin

A range of other anti-cancer drugs are being tested for their effectiveness in treating peritoneal mesothelioma. Some have shown success in chemotherapy for other types of cancer. Chemotherapy drugs that have not been approved by the FDA can be accessed in clinical trials. These specialist-run trials are leading to a better understanding of mesothelioma treatment and charting the course for new possibilities. Talk to your doctor today to learn about possible opportunities to participate in clinical trials.

Side Effects of Chemotherapy in Pleural Mesothelioma Patients

Side effects are often part of the chemotherapy process. Many of these side effects occur from the damaging of healthy cells by cytotoxic agents.  Cell division is a natural process, and it occurs in healthy tissue as well. Cancer cells divide and multiply much more rapidly and the chemotherapy drugs aim to target these rapidly dividing cells.

Because most cells in the adult human body divide much less frequently, the drugs usually don’t affect healthy cells. However, there are some cases where normal cells are affected. This scenario is particularly likely to involve the hair follicles, as well as the cells in the linings of the mouth and gut because these multiply rapidly compared to other cells in the body. Luckily, these cells can self-repair, so the effects are not permanent. However, the temporary changes are what result in some common chemotherapy side effects.

These include:

  • Partial or complete hair loss
  • Gastrointestinal discomfort or constipation
  • Nausea and vomiting
  • Loss of normal appetite
  • Lowered immunity
  • Fatigue
  • Mouth sores
  • Peripheral neuropathy (loss of feeling in certain parts of the body)
  • Fogginess and forgetfulness (chemo brain)
  • Loss of red and white blood cells, low platelet count leading to bruising or bleeding

These are just a few of the potential side effects that can result from chemotherapy for peritoneal mesothelioma. Side effects should be discussed candidly with your doctor so that he or she may pick up on any unusual occurrences, or suggest tips for managing symptoms. Your doctor might also be able to provide prescriptions for mitigating side effects.

If you notice any severe, unusual side effects, seek medical attention immediately. Unexpected reactions to certain chemotherapy drugs may indicate that your treatment should be adjusted.

Alleviating Chemotherapy Side Effects

Although it can be intimidating to learn about the types of side effects chemotherapy can cause, you may not experience all of them. You can also take matters into your own hands and make some changes to alleviate the severity of side effects.

Ensure you:

  • Get adequate sleep each night
  • Exercise well within your limits
  • Avoid contamination and infection from others
  • Eat healthy meals and stay hydrated
  • Avoid smoking
  • Mitigate nausea with home or over-the-counter remedies
  • Keep your mind active to keep chemo brain at bay: try puzzles, quizzes, and light reading
  • Don’t be afraid to accept as much help and support from your friends and family as you need

Follow-Up After Chemotherapy

After your chemotherapy treatment ends, you will have follow-up visits with your doctor. During this time, your specialist will assess your prognosis, discuss your response to the treatment, and provide answers to any questions you (or your family) might have. If necessary, your doctor may recommend additional treatments or a second line of chemotherapy.

In these follow-up visits, it’s extremely important to be open and trusting, and let your doctor know about any concerns or unanticipated side effects. This is the only way they can get a full picture of your response to the chemotherapy and move forward appropriately.

It’s also completely normal to have non-physical responses to chemotherapy. The process can take a toll emotionally and mentally as well. If you are struggling with what is sometimes referred to as the hidden side effects of this intensive treatment, you are not alone. Your doctor can provide you with resources to help you and your loved ones cope. Make sure you communicate with those closest to you as well.

There is plenty of support out there, so be sure to take full advantage of it if you need to do so.

Learning about chemotherapy for peritoneal mesothelioma is often helpful for patients considering this form of therapy. However, the right treatment plan will be different for each patient. To learn about what kind of chemotherapy is best for you and receive personalized advice on your treatment options, you should see a mesothelioma specialist.