5 Most Effective Chemotherapy Drugs for Pleural Mesothelioma

Chemotherapy is a conventional treatment for cancer which reduces the size of tumors by destroying malignant cells. It involves one or a combination of multiple anti-cancer drugs (formally called chemotherapeutic agents). Although chemotherapy by itself will rarely cure cancer, it can substantially relieve some of the symptoms, improve the quality of life and extend life expectancy. When used in conjunction with surgery or radiation therapy, the effectiveness of chemotherapy increases considerably.

Depending on the stage of cancer and other factors, chemotherapy can be received:

• before surgery (neoadjuvant therapy) – if the tumor is too large to be safely removed, one or multiple chemotherapy cycles will be required to shrink it
• after surgery (adjuvant therapy) – in order to prevent the development of a new malignant tumor, chemotherapy may be recommended to ensure that no malignant cells remain in the body following surgery
• by itself – if mesothelioma is detected early when cancer has not reached an advanced stage, chemotherapy alone might lead to its remission and alternatively, if the tumor cannot be removed surgically for various reasons, anti-cancer drugs will be the only treatment option
• with other treatments (multimodal approach) – chemotherapy is employed along with surgery and/ or radiation therapy for better results whenever possible
• as a palliative treatment – patients with advanced cancer are rarely eligible for aggressive surgery and in such cases, chemotherapy will represent the only treatment they can receive to alleviate their symptoms

At the moment, there are over 100 anti-cancer drugs available for the treatment of mesothelioma. Deciding on the most efficient and, at the same time, low-risk chemotherapy drug is a very difficult task, as each patient is unique. There are multiple factors which need to be carefully assessed prior to prescribing a certain treatment, such as the stage of the disease, the overall health of the patient and their age. If you suffer from pleural mesothelioma, only a medical oncologist with relevant experience in diagnosing and treating it will be able to recommend the most appropriate and safe treatment for you

For pleural mesothelioma, there are two methods of delivering chemotherapy:

• Systemically. The drug is administered intravenously or taken in the form of a pill. It subsequently enters the bloodstream and travels through the body, destroying cancer cells regardless of their location.
• Intrapleurally. The drug reaches the inside of the chest directly via a catheter (a thin tube inserted into the chest cavity). This way, a larger amount of anti-cancer medication is delivered to the affected area, while the rest of the drug is absorbed into the bloodstream.

Side effects represent a widespread concern among cancer patients. Unfortunately, all medication entails a series of side effects, including chemotherapy drugs. Their intensity can range from mild to severe, depending on both the drug and your body’s reaction to it. However, it is important to remember that chemotherapy is vital for your prognosis and sometimes, it is the only treatment you can safely undergo. The good news is that most unpleasant symptoms caused by chemotherapy disappear after the completion of your treatment and permanent side effects are rare.

Nevertheless, despite the numerous chemotherapy drugs available for pleural mesothelioma, reliable medical studies and the results of well-conducted clinical trials have recently suggested that some are generally more effective than others. Similarly, certain combinations of anti-cancer drugs were associated with a higher survival rate. We have compiled a list of five chemotherapy drugs which have shown positive results in the treatment of pleural mesothelioma, including the most efficient drug combinations.

1. Cisplatin (Platinol, Platinol-AQ)

Cisplatin has been used in the treatment of cancer since 1978. In combination with other anti-cancer drugs, it is very beneficial for pleural mesothelioma patients, significantly extending their life expectancy. Cisplatin is a platinum-based drug. It is administered intravenously over the course of two hours once every 3 to 4 weeks.

During treatment, it is highly recommended to increase your intake of fluids and to begin taking B12 supplements at least one week before the first chemotherapy cycle. A folic acid supplement and an oral steroid might also be prescribed to mesothelioma patients who undergo chemotherapy with Cisplatin to reduce the severity of side effects.

Cisplatin and Pemetrexed is the most effective drug combination for pleural mesothelioma. It is usually administered every 21 days. This combination has been associated with a 1-year survival rate for 63% of the mesothelioma patients who participated in the study.

Another combination which has been revealed to be helpful for mesothelioma patients with metastasized cancer is Cisplatin and Navelbine. Approximately 35% of those who participated in the study survived for one year or more.

Some of the most common side effects of Cisplatin are:

• low red blood cell count
• nausea and vomiting
• kidney toxicity
• blood test abnormalities (low potassium, low calcium etc.)
• fatigue
• low white blood cell count

2. Pemetrexed (Alimta)

As previously mentioned, this drug is typically used in combination with Cisplatin. It works by blocking the enzymes involved in DNA replication and cell division. Pemetrexed is administered intravenously over the course of 10 minutes, either in a vein in your arm or in a large vein in your chest through a portacath, central line or PICC line. You will generally have to receive it every 3 weeks, but your physician might recommend you a different treatment plan, depending on your health and the stage of mesothelioma.

Because Pemetrexed inhibits the action of folic acid within the body, you will also have to take supplements at least 5 days before starting chemotherapy, as well as have B12 injections before and during treatment. Thereby, the side effects will be somewhat reduced and your body will still benefit from these nutrients.

A good combination for pleural mesothelioma patients who cannot tolerate Cisplatin is Pemetrexed and Carboplatin, which is another platinum-base anti-cancer drug. In a medical study involving patients with metastasized pleural mesothelioma, this combination resulted in a 1-year survival for 44% of the participants. Additionally, in the second phase of a 2006 clinical trial, nearly 19% of the 102 pleural mesothelioma patients experienced partial tumor remission, while the tumors disappeared completely for two of them. The average survival time was 12.7 months and 47% of them did not develop any new malignant tumors following treatment.

The most common side effects of Pemetrexed include:

• fatigue
• low red blood cell count
• loss of appetite
• constipation
• nausea and vomiting
• low white blood cell count
• chest pain
• dizziness
• low platelet count

3. Gemcitabine (Gemzar)

This chemotherapy drug slows the developments of malignant tumors by destroying cancer cells and inhibiting DNA replication. It may be a suitable alternative for mesothelioma patients who are sensitive to platinum-based drugs such as Cisplatin or Carboplatin. Gemcitabine is administered intravenously during 30 minutes, usually once a week for approximately 7 weeks.

Gemcitabine and Cisplatin could be an effective combination for people suffering from pleural mesothelioma. The second phase of a clinical trial conducted in 2002 reported a 33% response rate, with patients experiencing partial tumor remission.

Another potentially effective drug combination is Gemcitabine and Pemetrexed. Following this treatment, 28% of pleural mesothelioma patients with metastasized cancer survived for one year or more.

Some of the side effects of Gemcitabine are:

• skin rash
• fever
• low blood cell counts
• flu-like symptoms
• loss of appetite
• fatigue
• nausea
• chest pain
• blood in urine
• change in kidney function
• mouth sores

4. Doxorubicin (Adriamycin, Rubex)

Doxorubicin has been involved in the treatment of cancer since 1984 when the drug was approved by the FDA. It is administered intravenously as well, over the course of 15 minutes, once every three to four weeks. This anti-cancer drug interferes with the synthesis of DNA and prevents cancer cells from multiplying and spreading through the body.

Pleural mesothelioma patients may benefit from chemotherapy with Doxorubicin and valproic acid. 36% of the 45 patients who participated in the second phase of a 2011 clinical trial have not developed any new tumors, while 16% of them experienced partial remission. The average survival time for patients whose tumor had shrunk was 16.7 months.

The most frequently encountered side effects caused by Doxorubicin include:

• irregular heartbeat
• nausea
• mouth sores
• loss of appetite
• low blood cell counts
• pain in the region where the drug was given

5. Carboplatin (Paraplatin)

Carboplatin was introduced as a chemotherapy drug in the late 1980s. It works by breaching the cellular wall and binding to the DNA of malignant cells, which prevents them from multiplying. This way, cancer cells are eventually destroyed. For pleural mesothelioma patients, Carboplatin is administered intravenously once every 28 days. It is one of the anti-cancer drugs with the least side effects. Chemotherapy with this drug is not recommended for those who suffer from kidney disease.

The main side effects associated with Carboplatin administration are:

• low magnesium levels
• changes in taste
• nausea and vomiting
• fatigue
• loss of appetite
• low blood cell counts (red blood cells, white blood cells, and platelets)
• stomach pain