Malignant Mesothelioma: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines travel all through your body in your bloodstream. They attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

When might chemotherapy be used for mesothelioma? 

Chemo is part of the treatment for many people with mesothelioma. It may be used:

• Before surgery if your cancer has not spread to other parts of your body. Chemo can be used to try to shrink the tumor to make it easier to remove. This is called neoadjuvant therapy.

• After surgery to try to kill any remaining cancer cells. This can delay or even keep the cancer from coming back. This is known as adjuvant chemotherapy.

• As the main treatment (either alone or with radiation) if you have cancer that has spread, or if you aren’t healthy enough for surgery. Chemo can help shrink or control the cancer.

How is chemotherapy given for mesothelioma?

Before treatment starts, you’ll meet with a medical oncologist. This healthcare provider specializes in treating cancer with medicines like chemo. They will talk with you about your treatment choices and explain what you might expect. 

For mesothelioma, chemo can be given in these ways: 

• (IV) intravenous. The chemo is given through a small catheter that's been put into a vein. It may drip in slowly over a few hours. Or it may be given more quickly over a few minutes. It travels through your blood to kill cancer cells all over your body.

• Intraperitoneal. For people with peritoneal mesothelioma that’s been removed with surgery (ccytoreductive surgery), chemo may be put right into the belly (abdomen). This can be done during the surgery, right after the cancer has been removed. It can also be done after surgery. This method uses a machine that circulates the chemo in and out of the belly through soft tubes (called catheters). The machine also heats the chemo to help it work better. This is often called HIPEC (hyperthermic intraperitoneal chemotherapy).

IV chemotherapy is normally given in an outpatient setting. You get it at a hospital clinic, infusion center, or healthcare provider's office and go home after treatment. Less often, you may need to stay in the hospital during treatment. Your healthcare providers will watch you for reactions during your treatments. Each chemo treatment may last for a while. So you may want to take along something that’s comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

You get chemotherapy in cycles over a period of time. That means you get the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps:

• Kill more cancer cells. The medicine can kill more cancer cells over time, because cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.

• Give your body a rest. Treatment is hard on other cells that divide quickly. This includes cells in the lining of your mouth and stomach. It causes side effects, like mouth sores and upset stomach. Between cycles, your body can heal and get a rest from the chemo.

• Give your mind a rest. Getting chemo can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

Your healthcare provider will talk with you about your schedule so you know what to expect.

What common medicines are used to treat mesothelioma?

These are some common chemo medicines used to treat mesothelioma:

• Cisplatin

• Carboplatin

• Doxorubicin

• Gemcitabine

• Paclitaxel

• Pemetrexed

• Vinorelbine

Pemetrexed plus cisplatin or carboplatin is often the first treatment after surgery. Some people may get only one chemo medicine. These include people who aren’t healthy enough to get two medicines or people who have already had chemo.

What are common side effects of chemotherapy?

Side effects of chemo are different for everyone. They vary based on the chemo medicine(s) and dose you get. Below is a list of the some of the most common chemo side effects. Ask your healthcare provider what short- and long-term side effects to watch for.

• Hair loss

• Nausea and vomiting

• Mouth sores

• Diarrhea

• Changes in the way things taste

• Loss of appetite

Other common side effects are linked to decreased blood counts, for instance:

• Low white blood cell

Increased risk for infection

During your chemo treatments, your white blood cell count may drop. This means your immune system won’t be working as well as it should. It’s a good idea for you to stay away from people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, sore throat, a new cough, or burning during urination.

Bleeding and bruising more easily

Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well. 

Fatigue

You may feel tired while getting chemo. This normally goes away once treatment ends. 

Other side effects

Sometimes other side effects can be seen with certain chemo medicines. For example, cisplatin and carboplatin can cause nerve damage (peripheral neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. It might get better after treatment, but it may last a long time or be permanent for some people. Tell your treatment team about any changes you notice while getting chemo. Some may need to be treated to keep them from getting worse.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of all your chemo medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when to call them. For instance, chemo can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends and holidays?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.