Mesothelioma Medications

What Kinds of Medications Are Available to Treat Mesothelioma?

The most common medications used to treat mesothelioma are chemotherapeutic agents. Some patients may also benefit from other types, like immunotherapy drugs, targeted drugs, and others.

1. Chemotherapy. Chemotherapeutic drugs are not very specific. Most often administered systemically throughout the entire body, they target fast-growing cells, like cancer cells.
2. Photodynamic Therapy. This new type of therapy relies on more targeted medications. Delivered to the tumor site, they only become active when exposed to light.
3. Antiangiogenesis. These are drugs that stop the growth of new blood vessels in tumors, essentially starving them of oxygen and nutrients.
4. Immunotherapy. Various types of immunotherapy drugs empower the patient’s immune system to recognize, attack, and kill cancer cells.
5. Targeted Therapy. This category includes different types of medications that target particular weaknesses in cancer cells.
6. Palliation. Doctors use some medications, like painkillers, to give patients symptom relief and improved quality of life.
7. Emerging Medications. Researchers continue to develop and study new medications. Many current clinical trials are working on new immunotherapies and targeted therapies, but emerging medications exist in all categories.

Can Any Medication Cure Mesothelioma?

Curing mesothelioma with any treatment strategy is unlikely. Experts consider this a terminal cancer. The few patients who achieve remission have an early-stage diagnosis and undergo multimodal treatment.

Surgery is the most effective way to achieve remission, often used along with chemotherapy or other types of medication. Medications alone cannot cure mesothelioma.

Are Mesothelioma Medications FDA-Approved?

The U.S. Food and Drug Administration (FDA) has approved a handful of drugs for treating pleural mesothelioma:

• Pemetrexed (Alimta)
• Cisplatin
• Gemcitabine
• Nivolumab (Opdivo)
• Ipilimumab (Yervoy)

The first three of these are chemotherapy drugs. The second two are immunotherapy medications. The FDA has not approved many medications, but doctors may use many unapproved drugs at their own discretion and as a part of clinical trials.

Chemotherapy Medications Target Fast-Growing Cells

The first line of treatment for most patients with mesothelioma is chemotherapy. It involves using medications that kill cancer cells during their rapid growth and cell division. Unfortunately, these medications are not specific to tumors. This means that while chemotherapy drugs kill cancer cells, they also damage healthy cells that grow quickly, like blood cells and hair follicles.

Only a few drugs are approved for first-line use in chemotherapy for mesothelioma:[1]

• Pemetrexed
• Cisplatin
• Gemcitabine

Despite the unpleasant and often difficult side effects that they can cause, chemotherapy medications are one of the best and most effective treatments for a number of cancers, including mesothelioma. Patients must endure these side effects to receive the benefits.

This doesn’t mean that other chemotherapy drugs cannot be used in mesothelioma treatment. Doctors may prescribe other chemotherapy agents such as carboplatin, doxorubicin, and navelbine. However, these alternatives have not been clinically proven to be as effective, or they are still in trials to prove safety and efficacy.[2]

Photodynamic Drugs Rely on the Power of Light

Another type of medication some treatment teams may use for mesothelioma treatment is a photosensitizer. This is also known as a photodynamic drug or a photosensitizing agent. These are agents that become activated to kill cancer cells when exposed to light.[4]

Different drugs of this type are activated by different wavelengths of light, which can travel varying distances through the body. The location of the tumor determines the choice of drug and wavelength of light.

To be treated with a photodynamic drug:

• A patient is injected with the optimal photosensitizing agent.
• The drug travels to all areas of the body but stays longer in cancer cells than in healthy cells.
• After two or three days, most of the medication has been eliminated from the healthy part of the body, but it lingers in the tumors.
• The doctor can then insert a light on the end of an endoscope into the body.
• They aim it at the tumor to activate the medication, which then kills cancer cells.

Photodynamic medications are not commonly used to treat mesothelioma, but researchers continue to develop it as a treatment strategy. Some studies have found that photodynamic therapy improves survival time when used with surgery.[5]

Antiangiogenic Medications Starve Tumors

Another critical line of research in targeted therapy is called antiangiogenesis treatment. Angiogenesis is the process of making new blood vessels, which is usually a normal and healthy process in the body.

However, this process is exploited in cancer to rapidly build new blood vessels to provide the tumor with oxygen and nutrients. If a medication can stop or slow the building of blood vessels, it may slow the growth or kill the cells in the tumor by limiting their blood flow.

Some antiangiogenesis medications have proven to be disappointing in trials, but others show promise. These agents often work best when used in conjunction with chemotherapy.[6]

Bevacizumab (Avastin) is the most commonly used antiangiogenic medication used for mesothelioma patients. Although not approved yet by the FDA, experts recommend using it in combination with chemotherapy for some patients.

Immunotherapy Mesothelioma Medications Harness the Immune System

Another novel line of attack against mesothelioma is immunotherapy. While there are a few similar agents, the general idea is to stimulate the immune system to recognize and attack cancer cells.[7]

Cancer cells are too similar to healthy cells in the body for the immune system to recognize and attack them. The immune system is unable to see them as foreign or harmful. To convince the immune system to attack, it must be pushed in some way:

• One type of immunotherapy medication works by making the immune system more active.
• Another method is to overcome cancer’s ability to evade detection.
• A third method is to specifically train the immune system by exposing it to small pieces of cancer in the hope it will recognize the tumor.

Some immunotherapy works better for certain types of cancers than others, and trials are ongoing to test for new options in patients with mesothelioma. Even more trials are ongoing that attempt to find more effective treatment combinations, focusing on the combination of chemotherapy and immunotherapy.

In October 2020, the FDA officially approved the first immunotherapy for pleural mesothelioma. The combination of Opdivo and Yervoy activates immune system T-cells and helps T-cells find cancer cells.[8]

Although not approved for mesothelioma, pembrolizumab (Keytruda) is another option for some patients. Like Opdivo, it uncovers cancer cells hiding under a protein called PD-1.

Doctors do not generally use immunotherapy as a first-line treatment for mesothelioma. They turn to it if tumors continue to grow after chemotherapy and in patients not eligible for surgery.

Targeted Medications Are More Specific

One of the upcoming lines of treatment in mesothelioma and other types of cancers is the development of drugs that are more specific than chemotherapy drugs. These are medications that recognize, target, and kill cancer cells only.

These drugs are so specific that some are being designed to target cells from specific types of cancer:[10]

• Mesothelin is a protein expressed mostly in mesothelioma tumors. Drugs that can specifically target this compound are currently being tested.
• Emerging research uses specific genes to better target mesothelioma cells. Researchers may be able to identify which treatments work best for patients based on their specific genetic mutations.
• One potential gene-targeted medication inhibits a particular enzyme active in patients with a BAP1 mutation. This may trigger cancer cell death.
• Adding enzymes supressed by genetic mutations may also help slow or stop the growth of mesothelioma cells.

Palliative Medications Aid Symptom Relief

Doctors also use many of the medications for treating mesothelioma as part of palliation. Palliative treatments are not curative. They help make patients more comfortable. Often, the best way to do this is to shrink tumors. Doctors may use chemotherapy and other treatment drugs in this way.

Other medications do not target the cancer but provide some relief from symptoms. These include painkillers to manage the pain caused by tumors. Patients may also benefit from drugs that target treatment side effects, for instance, anti-nausea medications to treat chemotherapy-related nausea.

Can I Try New Mesothelioma Medications in Clinical Trials?

Researchers study emerging medications in clinical trials. These are controlled studies with patient volunteers. If you qualify, you can join a trial and get access to a new drug without full approval.

Talk to your doctors about clinical trials. They can suggest trials that may be good options for you. They can also discuss with you the risks and benefits of participating.

As research continues, doctors and patients hope that newer medications will be even more effective and cause fewer side effects. Photodynamic drugs, antiangiogenesis agents, immunotherapy, and targeted medications show promise and can be better tolerated than chemotherapy. Much more research needs to be done, but even now, patients with mesothelioma and their doctors have many options for medication treatment.

Page Medically Reviewed and Edited by
Luis 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.

Connect with Mesothelioma Doctor Luis Argote-Greene, M.D.