Chemotherapy for Pleural Mesothelioma

Quick Summary

We know that chemotherapy is not a one-size-fits-all treatment and that treatment plans will vary from person to person based on a variety of existing factors in the patient profile. Likewise, the way doctors administer chemotherapy to pleural mesothelioma patients varies according to patient-specific factors.

Pleural mesothelioma manifests itself as cancerous tissue in the pleura (lung lining), the membranous lining of the lungs. It is the most common form of mesothelioma, affecting more than 75% of mesothelioma patients.

When it comes to treatment for Pleural mesothelioma, a multimodal approach is commonly recommended. Combining chemotherapy with a surgical procedure is usually the best way to increase a patient’s lifespan and quality of life.

Chemotherapy for Pleural Mesothelioma Quick Facts

  • Chemotherapy is the most common form of treatment used in mesothelioma patients
  • Treatment will be administered orally or intravenously
  • The success of HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is being explored for pleural mesothelioma patients. This treatment has shown significant effectiveness in improving the prognosis of peritoneal mesothelioma patients.

Surgical Procedures Used in Multimodal Therapy for Pleural Mesothelioma

Extrapleural Pneumonectomy

An extrapleural pneumonectomy is a surgical procedure used primarily to treat earlier stages of pleural mesothelioma.

It is combined with chemotherapy for maximal effectiveness. Early-stage patients and candidates in otherwise good health are more likely to be eligible for this surgery because of the workload placed on the remaining organs once a lung has been entirely removed. However, for approved candidates, an EPP can improve survival rates, make breathing easier, and generally enhance the comfort of patients with pleural mesothelioma.

An extrapleural pneumonectomy is a larger scale, more invasive procedure than a standard pleurectomy and it involves the complete removal of the affected lung. Parts of pleura (the lining of the thorax) and the pericardium, a membrane that envelopes the heart, are also removed.

After the surgeon removes the lung, he or she may introduce heated intrapleural chemotherapy before performing the reconstruction. This will allow any remaining cancer cells to be killed. As well, chemotherapy is often recommended for patients who have undergone the procedure, beginning at least five weeks after the surgery. These patients can also receive radiation therapy.

Pleurectomy with Decortication

A pleurectomy with decortication is another surgical procedure that can be used in combination with chemotherapeutic treatments to improve the effectiveness of each treatment.

This surgery involves the removal of the cancerous tissue in the pleura as well as tumor removal. However, the lung itself will not be removed. Candidates are eligible for this surgery if tumors have not expanded beyond the pleura and if there is a good chance that cancer will not be left behind.

Combining Surgery and Chemotherapy for Pleural Mesothelioma

Both the EPP and P/D are surgeries for pleural mesothelioma that work best when combined with chemotherapy. When chemotherapeutic treatment is applied in combination with surgery, there are two ways it can be administered. These methods are knowns as adjuvant and neoadjuvant chemotherapy.

Doctors use adjuvant chemotherapy after the patient has undergone surgery. The goal of administering chemotherapy adjuvantly is to kill remaining mesothelioma cells and prevent it from returning. Even if this method cannot prevent the mesothelioma from coming back, it can sometimes delay it.

Doctors administer neoadjuvant chemotherapy before surgery is performed. The aim of this method is to shrink the mesothelioma tumor as much as possible before surgery. This can make the surgical removal itself easier.

Chemotherapy for pleural mesothelioma is usually administered as a systemic therapy, meaning the drugs are circulated through the body via the bloodstream. While hyperthermic intraperitoneal chemotherapy is often used during surgery for patients with peritoneal mesothelioma, its effectiveness in treating pleural mesothelioma is still uncertain.

The Pleural Mesothelioma Chemotherapy Process

Chemotherapy Process Update

For pleural mesothelioma, chemotherapy is most commonly administered intravenously or taken orally, as a pill. These methods are both classed as systemic chemotherapy because the chemotherapy drugs are circulated throughout the bloodstream so that they can reach the whole body. The treatment plan for systemic chemotherapy is cyclical—patients will be given the treatment during sessions spaced several weeks apart. This process can go on for several months. The number of cycles, chemotherapeutic agents used, and dosage amounts are determined by the doctor, based on several factors.

Chemotherapy Drugs for Pleural Mesothelioma

Almitra, or Pemetrexed: The FDA approved an Alimta-cisplatin combination for the treatment of malignant pleural mesothelioma in 2004. This combination has shown to be the most effective in increasing the quality of life and lifespan for patients so far.

Cisplatin: A platin (platinum-based) drug that is one of the most common drugs used in chemotherapy for pleural mesothelioma. On its own, it’s effectiveness is limited. However, several drug combinations that include cisplatin yield high response rates. One example of such a combination is the highly successful Almitra-cisplatin treatment.

Bevacizumab, or Avastin: Also shown to increase lifespan when combined with Almitra and cisplatin.

Carboplatin: A platinum-based drug known for its lack of severe side effects. Often used in second-line treatments of pleural mesothelioma.

Cyclophosphamide: A cytotoxic agent that specialists use in the treatment of other cancers including lymphoma, leukemia, breast, and lung cancers. Its effectiveness in treating pleural mesothelioma is yet to be determined, but the drug is being explored and tested for this purpose.

Paclitaxel: Another anti-cancer drug that has specialists use in the treatment of various other cancers, including solid tumor cancers. The drug is administered intravenously, is a known irritant, and its effectiveness for mesothelioma is undetermined.

Gemcitabine: An antimetabolite anti-cancer drug previously used in pancreatic cancer, soft-tissue sarcoma, ovarian, breast, lung, and bladder cancers. Sometimes combined with platins or other chemotherapy drugs as part of second-line treatment for mesothelioma.

Doxorubicin: An anthracycline antibiotic anti-cancer drug that has been shown to increase the lifespan of mesothelioma patients. It is also being tested for its use in Heated Intraperitoneal Chemotherapy. It is also a vesicant, meaning that it can lead to tissue damage and even blistering if the drug escapes from the vein during intravenous treatment. As a result, it must be administered very carefully.

What to Expect With Chemotherapy

There is no one specific chemotherapy plan given to a patient. However, the chemotherapy process is usually fairly standard. The process begins with a consultation, in which you will learn about the results of your bloodwork. This is a great time for patients to ask preliminary questions.

Before treatment starts, you should read about the potential side effects and discuss these with the specialist. That way, you can prepare in advance for the onset of these side effects and prevent them from impacting your life more than necessary. You can also check with your doctor to see if any medications can be prescribed to prevent side effects from occurring or reduce their severity.

The chemotherapy treatment itself often consists of 3 to 4 “courses,” with three week rest periods scheduled in between. When you arrive for your treatment,  a nurse will supervise you and ensure that the dosage is correct, and the drugs are administered appropriately. Sometimes you will need to have additional blood work done to monitor the effectiveness of the treatment.

After treatment, you will begin follow-up visits. During these appointments, the doctor will likely discuss the progression and success of the treatment, and may possibly recommend additional therapies. You can also ask additional questions during these visits and inform the doctor of any further side effects you may be experiencing.

Contact our Patient Advocates today if you have any questions about paying for chemotherapy treatment. We can also help answer any other questions about chemotherapy for mesothelioma, or connect you with a mesothelioma specialist who can provide more expertise on treatment.