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Malignant Mesothelioma: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. These medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can also damage 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. Whether or not you get chemo depends mainly on these factors:

  • The stage (extent) of the cancer

  • Where the cancer is

  • The goal of treatment

  • Your age and general health

  • Concerns you have about side effects

  • What treatments you have had in the past (if any)

Your healthcare provider may recommend chemo to treat mesothelioma in situations like these:

  • 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 surgery easier. (This is called neoadjuvant therapy.) 

  • After surgery to try to kill any remaining cancer cells. (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 is a doctor who specializes in treating cancer with medicines such as chemo. The doctor will talk with you about your treatment options and explain what you might expect. 

For mesothelioma, chemo can be given in these ways: 

  • (IV) Intravenous. The chemo is given through a small needle 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 treated with surgery, chemo may be put right into the belly (abdomen). This can be done during the surgery after the tumors have 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 sometimes called HIPEC (hyperthermic intraperitoneal chemotherapy).

IV chemotherapy is normally given in an outpatient setting. You get it at a hospital, clinic, 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’ll get chemo in cycles. This is done to reduce the damage to healthy cells and give them a chance to recover. Each cycle consists of 1 or more days of treatment, followed by a time to rest. Cycles normally last 3 or 4 weeks. Most people get 4 to 6 cycles as part of their early treatment. This often lasts for several months. 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 drugs used to treat mesothelioma:

  • Cisplatin

  • Carboplatin

  • Doxorubicin (as part of HIPEC)

  • Gemcitabine

  • Paclitaxel (as part of HIPEC)

  • Pemetrexed

  • Vinorelbine

Pemetrexed plus cisplatin or carboplatin is often the first treatment. Some people may only get one chemo medicine. These include people who aren’t healthy enough to get 2 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 you get. Below is a list of the some of the most common chemo side effects. Ask your healthcare provider what side effects to watch for.

Hair loss

If you have hair loss, the hair will often grow back after the treatment stops.

Nausea and vomiting

This side effect can often be controlled and even prevented with medicines. Ask your healthcare provider about it.

Mouth sores

Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and stay away from foods and substances that could irritate your mouth.

Diarrhea

If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

Loss of appetite or changes in the way things taste

Talk with your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.

Increased risk of 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 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. 

Sometimes other side effects can be seen with certain chemo medicines. For example, cisplatin and carboplatin can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. 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?

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.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 3/1/2019
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