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. The injected drugs circulate throughout the body and target cancer cells wherever they are.
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.
Chemotherapy may be a frightening option, as the side effects are well known and 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, the entire system. 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 on an intravenous drip.
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)
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.
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. 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 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.
Chemotherapy is infamous for causing uncomfortable side effects. Going through a cycle of chemotherapy can be very challenging, and some people even give up it because of the discomfort. Patients in the end stages of mesothelioma 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. 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.
Multimodal Treatment with Chemotherapy
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 one of the most effective therapies for mesothelioma. Make sure you have loved ones around to support you as you go through cycles of chemotherapy. It won’t be easy, but it will hopefully help you improve your overall health as you battle cancer.
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.