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Chemotherapy is the administration of drugs that kill cancer cells. They also kill healthy cells, which is why this line of treatment causes so many unpleasant side effects. Mesothelioma, the cancer of the mesothelium, most often the lining of the lungs called the pleura, is aggressive and spreads quickly. Chemotherapy is just one of several treatment options that doctors and patients have.

Mesothelioma chemotherapy may be used in multiple ways: as part of an attempt to cure the cancer, to prepare a patient for surgery, after surgery to reduce the risk of a recurrence, to shrink the cancer as part of palliative care, or along with other techniques in an overall treatment plan. There are several different drugs used for mesothelioma chemotherapy, and researchers are working on developing better drugs with fewer side effects.

What is Chemotherapy?

Chemotherapy is a treatment strategy that uses cytotoxic, or anti-cancer, drugs that kill cancer cells. The most common way to give this treatment is through an intravenous injection. The drugs can then travel throughout the body through the blood stream and target cancer cells wherever they are. Chemotherapy drugs target cells that grow and divide rapidly, which means that certain healthy cells, like those in hair follicles, are also targeted.

Chemotherapy may be a frightening option, as the side effects are well known to include nausea, hair loss, and pain, but it can be useful and may even relieve symptoms of the cancer as well as playing a role in potentially curing it. Chemotherapy has the potential to be very 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?

The most common type of chemotherapy is called systemic because the drug is released into the blood stream and can then circulate throughout the body. Systemic chemotherapy may be administered as a pill, but most often it is given intravenously. This is typically an outpatient procedure and involves sitting in the hospital or medical center while the intravenous drip administers the drug into your veins.

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 drugs are harsh and hard to take for most people, even healthy people. The rest period between cycles is important for this reason.

Heated Intraperitoneal Chemotherapy (HIPEC)

A special type of chemotherapy is sometimes used for peritoneal mesothelioma, and more recently for pleural mesothelioma in some cases, although this use is controversial. HIPEC involves injecting heated chemotherapy drugs into the abdominal cavity. Research has found that many chemotherapy drugs work better when they are heated and the direct contact with the cancer in the abdomen means fewer overall side effects from treatment. 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.

Chemotherapy Drugs for Mesothelioma

There are many different chemotherapy medications on the market and new ones being developed all the time. Some are used more often for mesothelioma. Mesothelioma patients may also be given a combination of two different drugs for a more effective treatment. The side effects may be worse with two, though, so only using one is always an option. Some of the most common mesothelioma chemotherapy drugs are:

  • Carboplatin
  • Cisplatin
  • Doxorubicin
  • Gemcitabine
  • Methotrexate
  • Mitomycin
  • Navelbine
  • Onconase
  • Pemetrexed
  • Vinorelbine

For HIPEC, the most common choices are either mitomycin by itself or a combination of doxorubicin and cisplatin.

Side Effects

Chemotherapy is infamous for causing uncomfortable side effects. Some people even give up on chemotherapy because of the discomfort. Patients who are at the ends of their lives may choose to forgo chemotherapy in order to live out the rest of their lives at home and in relative comfort. Because these drugs target cells that divide quickly, not exclusively cancer cells, they kill many healthy cells and this is what causes side effects. The most common side effects of chemotherapy are:

  • Loss of appetite, weight loss
  • Nausea and vomiting
  • Hair loss
  • Diarrhea
  • Mouth sores
  • Bleeding and bruising
  • Fatigue
  • Increased infections

The bleeding and bruising side effects are a result of the chemotherapy drugs reducing the amount of platelets in the blood. This effects clotting and causes unusual bleeding. Fewer red blood cells contribute to the fatigue many patients feel undergoing chemotherapy. The increased risk of infections is a result of the damage that the drugs do to white blood cells, a crucial part of the immune system.

Chemotherapy and a Multimodal Approach

Most patients being treated for mesothelioma will receive a multimodal treatment strategy, meaning that multiple techniques are used for the best results. Chemotherapy may be used to shrink tumors before a surgery, for example. A 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 has been done 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 recur 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 suggest chemotherapy, it helps to know what to expect. It is not the most comfortable treatment, but it is used because it is often effective. Make sure you have loved ones around to support you as you go through cycles of mesothelioma chemotherapy. It won’t be easy, but it will hopefully help you improve your overall health as you battle cancer.

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