For patients with mesothelioma, drug therapy is a treatment option that has shown some success. Drugs that destroy or reduce cancer cells have been used for decades, and new, more effective cancer drugs are always being developed. Mesothelioma drug therapy has helped many patients live longer and more comfortably. The medical term for the treatment is chemotherapy; with mesothelioma it is almost always used in conjunction with radiation treatments.
Because malignant mesothelioma is often diagnosed beyond its early stages many cases are past the point that surgery could accomplish much. The cancer has spread beyond the point that surgical resection is an option, or the patient is too old or too ill to withstand major surgical intervention. In those instances, chemotherapy becomes the primary treatment option along with radiotherapy. The importance of drug therapy as a primary treatment for mesothelioma has led to clinical trials seeking the right combination of drugs that will have an impact at high doses.
Types of Mesothelioma Drug Therapy
The drugs most commonly used to treat mesothelioma today, pemetrexed and cisplatin, have not proven to be as effective as sole treatments as they are together. For that reason the baseline drug therapy treatment for epithelioid mesothelioma is the combination of these two drugs. Epithelial cancer cells are the most common of the three types of cancer cells that cause mesothelioma and the most responsive to treatment. Sarcomatoid cells, much less common, are more aggressive in their growth and more difficult to treat. The third type of mesothelioma cell configuration is biphasic, which is a combination of the two cell types.
Mesothelioma drug therapy can be by oral administration (pills) or by injection of the drugs into a vein, muscle, or chest or abdominal cavity. Regardless of the way the drugs are given, they will enter the bloodstream and circulate throughout the patient's body.
A method of drug treatment that has shown success in recent years is injection of the medication directly into the chest cavity (in the case of pleural mesothelioma) or into the abdominal cavity (for peritoneal mesothelioma). This treatment is called either intrapleural chemotherapy or intraperitoneal chemotherapy and is often conducted with heated (hyperthermic) medication. This technique allows the chemotherapy drugs to reach the diseased tissue without harming healthy cells as it would if delivered intravenously.
FDA Approval for Drug Treatment
The combination of pemetrexed (Alimta, manufactured by Eli Lilly) and cisplatin (Platinol, made by Bristol Meyers and several others), has been approved by the U.S. Food and Drug Administration (FDA), specifically for the treatment of inoperable malignant mesothelioma. In clinical studies, mesothelioma patients who were treated with pemetrexed and cisplatin together had longer average life expectancies than patients treated with cisplatin alone although the extension of survival time was a few mere months.
These are the only medications approved by the FDA for use in treating mesothelioma. Another drug, Oncanase, remains in Phase III clinical trials awaiting FDA approval. However physicians can use other anti-cancer medications to treat mesothelioma, and in some cases they have achieved positive using one or more of these as part of a combination of drugs. Those medications include:
- Carboplatin
- Docetaxel
- Erlotinib
- Etoposide
- Gemcitabine
- Irinotecan
- Paclitaxel
- Topotecan
- Vinorelbine
Mesothelioma Drug Therapy Side Effects
The drugs that are used to attack cancer cells are generally very toxic, damaging normal cells as well as malignant ones. When a patient's normal, healthy cells are damaged, he or she may experience troubling side effects such as a low blood cell count, which raises the risk of bleeding and infection. In addition, symptoms of nausea, fatigue, decreased appetite and hair loss may develop after mesothelioma drug therapy.
Discuss Treatment Options with Your Physician
If you've received a diagnosis of mesothelioma, it's in your best interest to find out as much as you can about the available treatments and the clinical trials in your area. Your physician can tell you more about mesothelioma drug therapy and other treatments that may delay the progression of the disease.
Sources:
- Cisplatin, Pemetrexed, and Imatinib Mesylate in Malignant Mesothelioma, ClinicalTrials.gov, NIH, http://clinicaltrials.gov/ct2/show/NCT00402766
- What is Malignant Mesothelioma, American Cancer Society, http://our.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_malignant_mesothelioma_29.asp?sitearea=
- Mesothelioma Treatments & Drugs, Mayo Clinic, http://www.mayoclinic.com/health/mesothelioma/ds00779/dsection=treatments-and-drugs
- Phase III Study of Pemetrexed in Combination With Cisplatin, Journal of Clinical Oncology, Vogelzang et al, 2003, http://www.jco.ascopubs.org/cgi/content/full/21/14/2636
