Mesothelioma info

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying.

While the recommended treatment for mesothelioma will no doubt vary from patient to patient and doctor to doctor, the form of cancer treatment most widely suggested is chemotherapy. Dealing with the idea of chemotherapy can be equally as frightening as the initial diagnosis of mesothelioma. Chemo conjures up thoughts of treatments that cause horrible side affects and often leave the patient feeling worse than if they had no treatments at all. However, because advances in chemotherapy drugs and medications to lessen the side affects have decreased some of the unpleasant effects of chemo, patients should remain open to the idea of undergoing this type of treatment and should listen with an open mind.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered “curative”, the goal is:

• To control the cancer by stopping its spread or slowing its growth.

• To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.

• To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.

• To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.

Quite simply, chemotherapy - treatment with a specific cancer drug or combination of drugs - kills cancer cells. Unlike surgery and radiation therapy, which can destroy cancer cells in one particular location, chemotherapy can be used to destroy cells that have metastasized - or spread to other parts of the body.

There are currently about 100 chemotherapy drugs on the market. Though single chemo drugs are sometimes used to treat a particular type of cancer, more often a few of these drugs are used in tandem. This is called combination chemotherapy. Some combinations have proved more helpful than others in fighting mesothelioma and its troublesome symptoms. Because all of these drugs work a bit differently, your oncologist will determine which are best suited to treating your disease. The doctor will also be able to determine the length of your course of treatment as well as the frequency of treatments.

Chemotherapy Drugs & Fact Sheets

• Alimta

• Carboplatin

• Cisplatin

• Gemcitabine

• Navelbine

• Onconase

The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a new drug recently approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly’s information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.

Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.

The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.

Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.

Side Effects of Chemotherapy

Cancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy. More on anti-nausea treatment for chemotherapy patients.

Chemotherapy is not a miracle drug, especially where mesothelioma is concerned, so it’s necessary to be patient when dealing with the treatment. Most patients receiving chemotherapy for the first time will be especially concerned about side effects. Different chemo drugs have different side effects, but your doctor should be able to tell you what to expect.

Because your doctor has experience with specific chemo drugs, he/she may also be able to tell you when to expect the side effects, how long they’ll last, and what to do about them. These days, there are many options available to help minimize or avoid these side effects so the chemotherapy of today is much different than that of decades or even years ago. Remember, also, that most of these side effects will disappear when the treatment has ended.

The most common chemotherapy side effects include:

• Nausea

• Vomiting

• Low white blood cell count (which leaves you prone to infection)

• Loss of appetite

• Constipation

• Fatigue

• Fever and chills

• Low platelet count (which may cause problems with clotting)

• Generalized achy-ness

• Tingling hands and feet

• Rash

• Depression

It’s important to tell your doctor about any side effects you might experience, even if they are noted as “common” side effects of your chemotherapy. High fever, inability to eat or drink, blood in the stool or urine, and signs of infection should be addressed immediately. Your doctor will inform you about other side effects which he/she considers life-threatening.