Over the years, researchers have developed chemotherapy into an effective treatment method for patients with all stages of mesothelioma. The ways in which chemotherapy is administered is being refined in top cancer centers across the country while new drugs are continually researched in clinical trials.
Types of Chemotherapy for Mesothelioma
Pre-Surgery: Chemotherapy given before surgery is known as neoadjuvant chemo. The purpose is to shrink mesothelioma tumors before surgery.
During Surgery: Chemo administered during surgery is known as intraoperative chemotherapy. This method is more aggressive but usually produces better results.
Post-Surgery: Chemotherapy after surgery is known as adjuvant chemo. Adjuvant therapy is designed to prevent mesothelioma from progressing after surgery.
Whether it is an FDA-approved treatment or a new experimental drug, chemotherapy can be given to a patient in a number of ways. An experienced mesothelioma specialist can help decide which type of chemotherapy will work best for a patient’s individual diagnosis.
Neoadjuvant chemotherapy is given to the patient before surgery. The goal of administering chemotherapy before surgery is to shrink the tumor and make it easier for the surgeon to remove.
A recent study on neoadjuvant surgery reported that the median survival rate for patients who underwent chemotherapy before an extrapleural pneumonectomy (EPP)experienced a median survival of 21.9 months.
Intraoperative chemotherapy is given to patients during surgery. One of the most successful applications of intraoperative chemotherapy is the Sugarbaker Procedure, which is also known as cytoreduction with HIPEC(heated intraoperative chemotherapy).
Doctors have used it to extend the overall survival rate of patients with peritoneal mesothelioma to 5 years and beyond.
During the Sugarbaker procedure, heated chemotherapy drugs are introduced into the abdominal cavity. The heated chemotherapy is then left in the abdominal cavity for 90 minutes. Specialists use this multimodal treatment to kill any cancer cells left behind after the EPP surgery. Killing these remaining cancer cells reduces the risk of the mesothelioma from recurring locally (growing back in the same place).
Intraoperative chemotherapy is also used for patients with pleural mesothelioma. A study conducted in 2012 reported that pleural mesothelioma patients who received hyperthermic intraoperative chemotherapy showed a substantially longer overall survival rate than patients who did not. Patients who received intraoperative chemotherapy experienced a survival rate of 35 months versus the 23 months for patients who only had surgery
Specialists use adjuvant chemotherapy after surgery is completed. The main goal of adjuvant chemotherapy is to prevent mesothelioma that was removed via surgery from returning. Platinol (cisplatin) plus Alimta (pemetrexed) is considered the most effective combination of chemotherapy drugs for use during adjuvant chemotherapy.
Chemotherapy can be given to mesothelioma patients in one of two ways. Which delivery method a specialist chooses depends on the location, stage and overall health of each patient.
Patients can administer chemotherapy themselves if their specialist prescribes the treatment in pill form. A promising new oral chemotherapy is pazopanib, a drug previously approved by the FDA for the treatment of kidney cancer. The trial, led by Dr. Juan Molina, reported an overall survival rate of 11.5 months, with one patient surviving 18 months.
The most common chemotherapy delivery method, intravenous chemotherapy can be administered in one of two ways: direct injection into the vein or via drip. Chemotherapy injected directly into the vein usually takes a few minutes. The drip method can take anywhere from 30 minutes to a few days.
Specialists have a number of options to give patients chemotherapy intravenously. It can infused via drip or injected directly through the following methods:
- Small tube inserted into a vein in the hand or arm
- A central line inserted into a vein in the chest or neck
- Port-a-cath (a small device implanted just below the skin) The device is a reservoir into which the doctor injects or drips the chemotherapy drug. The chemotherapy then flows from the reservoir through a tube and into the vein.
Choosing the Right Chemotherapy
Which type of chemotherapy works best for a patient depends on a number of factors. Where a patient’s mesothelioma is located, its cell type and cancer stage all play an important role in determining which type of chemotherapy will work best.
An experienced mesothelioma specialist can determine which type of chemotherapy will benefit a patient the most and devise a personalized course of treatment designed for their specific diagnosis.