What Is Chemotherapy?
Chemotherapy is a treatment strategy that uses cytotoxic, or anti-cancer, drugs to destroy cells in tumors. The most common way to give this treatment is through an intravenous injection. Chemotherapy circulates and targets rapidly dividing cells, like cancer. Unfortunately, it cannot tell the difference between cancer and other cells that naturally grow quickly in your body. This is what gives you side effects.
Most chemotherapy drugs are not specific in targeting cancer cells. They work on any cells that grow and divide rapidly, which means that certain healthy cells, like those in hair follicles, are also harmed by the drugs.
Management strategies for chemotherapy side effects have improved greatly over the years. There is now greater focus on prevention of side effects before they become an issue. This includes things like nausea and vomiting. Other common side effects may include fatigue, hair loss, increased risk of infections, bleeding or bruising, and taste changes. Chemotherapy has the potential to be effective in reducing the size of tumors, which is important in preventing the spread of the cancer, in making surgeries more successful, and in relieving symptoms caused by larger tumors.
How Is Mesothelioma Chemotherapy Administered?
Chemotherapy is considered a systemic therapy. This means that it goes everywhere in your body that blood travels. This allows for treatment not just for the visible cancer, but also cancer cells that may have spread to lymph nodes or other organs that are too small to see on imaging. The majority of chemotherapy for mesothelioma is given intravenously in outpatient cancer infusion centers.
Another way of administering chemotherapy drugs is to inject them directly into the part of the body where the tumor is. For mesothelioma chemotherapy, this means injecting it intrapleurally or intraperitoneally. For pleural mesothelioma the drugs may be injected right into the chest cavity, and for peritoneal mesothelioma, right into the abdominal wall.
Chemotherapy is typically administered in cycles. Each cycle lasts three to four weeks, after which there is a break to let the body recover. Chemotherapy side effects are different for everyone. Treatment effects can be cumulative, so they may become worse with the more treatment you receive. Your medical team can decrease the chemotherapy dose if your side effects become severe or more than you would like to tolerate.
Researchers looking for better outcomes for mesothelioma patients have developed a special type of chemotherapy for peritoneal mesothelioma. HIPEC involves injecting heated chemotherapy drugs into the abdominal cavity, typically after surgery to remove the bulk of cancerous tissue.
While research has found that some chemotherapy drugs work better when they are heated and infused directly into the abdomen, not all mesothelioma treatment facilities offer HIPEC because of the need for specialized equipment and training.
Because of the successes seen with HIPEC, researchers have begun to look into using a similar chemotherapy strategy for pleural mesothelioma. Some studies have found that the drugs are too quickly absorbed in the chest cavity, while others have found higher survival rates among patients being administered this treatment. It is still experimental and not available to all patients.
Chemotherapy Drugs for Mesothelioma
There are many different chemotherapy medications on the market with new ones being developed all the time. Mesothelioma patients may be given one or a combination of two different drugs for a more effective treatment. Some of the chemotherapy drugs used most often for mesothelioma are:
For HIPEC, the most common choices are either mitomycin by itself or a combination of doxorubicin and cisplatin.
Bevacizumab is another drug used to treat mesothelioma. It is a targeted therapy, so it works differently than chemotherapy. It aims to prevent blood vessels from reaching the tumor, making it harder for them to grow and spread. Since this affects all blood vessels in the body, it can stop wound healing necessary after surgery or procedures. Your doctor will discuss the right timing of this drug. This may be given in combination with chemotherapy.
Immunotherapy works very differently than chemotherapy. Instead of killing off cancer cells, it adjusts your immune system to find and kill cancer cells. Side effects are also very different from chemotherapy and are related to the immune system becoming overstimulated. Immunotherapy drugs recently approved for treating pleural mesothelioma include:
Chemotherapy Side Effects
Chemotherapy can affect everyone differently. Some experience side effects that can be worse than the cancer itself. When treatment causes more harm than good, patients may choose to focus on other means to make them feel better. Patients may choose palliative care or hospice services to help them manage the side effects of mesothelioma. Because these drugs target cells that divide quickly, not exclusively cancer cells, they kill many healthy cells. This is what causes side effects. The most common side effects of chemotherapy are:
- Loss of appetite, weight loss
- Nausea and vomiting
- Hair loss
- Mouth sores
- Bleeding and bruising
- Increased infections
Chemotherapy drugs cause significant damage to blood cells and platelets, which is what causes some of these symptoms. For instance, reduced platelets after chemotherapy triggers abnormal bleeding and bruising. A reduction in red blood cells causes fatigue, while damage to white blood cells can hamper the immune system, making infections more common.
Most patients being treated for mesothelioma will receive a multi-modal treatment strategy, meaning that multiple techniques are used for the best results. Chemotherapy may be used to shrink tumors before surgery, for example. Surgery to remove tumors has a greater chance of success if the tumors are smaller and less widespread.
Chemotherapy may also be used after surgery to remove tumors. In this case the drugs are used to kill any remaining cancer cells and to reduce the risk that the cancer will reoccur later. Radiation is used in a similar way and both strategies may be used before and after a surgery, or in some combination that best suits the needs of the patient.
If you have mesothelioma and your doctor suggests chemotherapy, it helps to know what to expect. Although chemotherapy can be effective to get rid of cancer cells, it is not always easy. Make sure you have loved ones around to support you as you go through cycles of chemotherapy.
What to Expect During Chemotherapy
Keep in mind that you’ll be in the hands of qualified medical experts. Your oncologist, who is part of the medical team, will let you know what medications you’ll receive and what the dosages will be prior to your first chemotherapy treatment session.
How Much Time Will It Take?
In most instances, after you receive your first cycle of medications, you won’t have to repeat it again for a few weeks. This allows physicians time to assess how well the chosen medications are working and it also gives the healthy cells in your body the ability to recover from the medications.
A typical treatment session can last minutes, hours, or sometimes days, according to the American Society of Clinical Oncology (ASCO). However, treatments that require several days, which are generally continuous infusion chemotherapy, do not require you to be at the hospital or medical center the entire time.
Home Care and Follow-up
Once you finish your treatment, your blood pressure and other vital signs will be checked. Your medical team will give you additional instructions before you leave for home care, but make sure you have the best contact number to reach someone on your medical team before you leave.
Your medical team will also let you know what foods and drinks you are allowed, that help the medication work the best. They will also go over possible side effects and what to do to help alleviate them.
It’s important to keep any follow-up appointments after your chemotherapy sessions are complete. The American Cancer Society states that follow ups could last for years, but it is an important part of the recovery process.
Manage the Top Three Chemotherapy Side Effects
As mentioned earlier, chemotherapy patients may have to deal with side effects, but there are things you can do at home to ease the discomfort.
According to the American Cancer Society, fatigue is a common side effect of chemotherapy. In addition to adequate nighttime sleep, consider taking naps throughout the day. Light exercise, such as small walks, sometimes help as well; however, don’t be hard on yourself if you cannot complete routine chores or you’re too tired to make dinner. Enlist the help of friends or family if possible or contact your doctor for possible home healthcare recommendations.
Nausea and Vomiting
Around 70% to 80% of chemotherapy patients will experience nausea and/or vomiting, according to in-depth clinical studies. This could cause weight loss, which is normal. Keep in mind that you probably won’t be up to eating like you did before chemotherapy started, but it’s important to eat small portions of food that are easy to digest. Your doctor can give you a diet to follow that can help fight nausea while getting adequate nutrition. Your doctor could also prescribe you an anti-nausea medication, such as Zofran or Aloxi.
Hair loss is a common side effect of chemotherapy and, although it may not be flattering, keep in mind that it means powerful medications are attacking cancerous cells and helping you heal. The same medication, however, also attacks your healthy cells, including your hair roots, where cells rapidly grow and divide.
Hair loss usually begins within a few weeks of treatment. It can fall out in large clumps or it could fall out gradually. Unfortunately, there is nothing in the form of treatment for hair loss, but there are other things to consider.
A scalp cooling cap is a cap placed tightly on the head that’s filled with chilled liquid. The liquid is said to restrict the blood flow in the scalp, which, in turn, can slow the process of hair loss.
Rogaine, a popular drug used for hair loss, is another possibility. Although it likely won’t stop hair loss, it may speed up the process of your hair growing back faster. Rogaine comes with its own side effects, however, so be certain to discuss the pros and cons with your physician before making a decision.
Some chemotherapy patients choose to wear wigs. In some instances, insurance may cover the costs for wigs. Check with your provider to see if you qualify.
Page Medically Reviewed and Edited byLuis Argote-Greene, M.D.
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.