Mesothelioma Chemotherapy | What to expect during Chemotherapy Treatment of Mesothelioma

The Mesothelioma Chemotherapy is a treatment option the usually combines pemetrexed and cisplatin drugs. These drug help in killing the cancer cells by shrinking the tumors, improving the quality of life of the patient and reducing any present symptoms.

Mesothelioma Chemotherapy | What to expect during Chemotherapy Treatment of Mesothelioma
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Mesothelioma Chemotherapy

Chemotherapy, which is commonly called Chemo, is a pattern of treatment used on mesothelioma patients to control growth and spread of the cancer tumors. The medication when administered travels through the bloodstream until they get to the area of the body affected by the mesothelioma cancer.

The fast-growing cancer cells are destroyed with the aid of this treatment. Chemotherapy can shrink tumors and limit or prevent formation of new tumors. This therapy helps patients to live longer by restricting growth of tumor.

The symptoms of the mesothelioma such as breathing difficulties and chest pain are also reduced with the help of chemotherapy, by shrinking the tumors that are pressing against the chest wall and the lungs.

Although mesothelioma cannot be cured by administering chemotherapy, the adverse effects of the symptoms of the cancer can be alleviated, and also quality of life alongside survival can be improved. The chemo treatment may also be combines with radiation therapy, surgery or emerging treatments by the doctors in charge.

Administering of the Chemotherapy Drugs

Chemotherapy can be tailored down to the circumstances of individual patients by cancer specialists. This therapy involves several medications, administration methods and dosage levels, and it remains the most common treatment option for the mesothelioma disease. Expert doctors in this field can deliver chemotherapy as heated wash during surgery or through an intravenous line into the blood.

Systemic Chemotherapy

Doctors or nurses usually administer the drugs through a port or an IV line in a vein during a systemic chemotherapy regimen for the mesothelioma. The medication exposes both healthy and cancerous cells to the chemotherapy as it circulates throughout the entire body system.

This delivery method is less invasive than receiving heated chemotherapy during treatment, although it is seen to likely cause more side effects.

The systemic chemotherapy may be administered alone, which is the most common method of treatment for all types of the malignant mesothelioma disease, or may administer the chemotherapy alongside other therapies.

Intraoperative Chemotherapy

This chemo is delivered during surgical operations when the cancer site is exposed and open. The technique requires the chemotherapy to be warmed up, and the use of a pump to rinse the cancer site with the medication, and a drain to drain out the fluid.

Doctors may refer to this procedure as intraperitoneal or intrapleural chemotherapy, depending on the type of mesothelioma.

The application of chemotherapy during surgery helps in targeting the tumor directly and in protecting the healthy areas of the body from chemotherapy exposure, and this reduces any risks of side effects.

Multimodal Treatment Plan for Chemotherapy

For Mesothelioma treatment, doctors sometimes combine chemotherapy with other treatment options such as radiation therapy or surgery. This approach offers a better chance at long-term survival, and is called the Multimodal Therapy.

There is a lower risk that cancer cells can resist or withstand this treatment when multiple therapies are combined. Mesothelioma patients that are eligible for this kind of treatment option are usually the ones that got early diagnosis or are healthy enough to withstand the aggressive nature of this treatment.

The following terms are usually used by doctors to describe the best times for administering chemotherapy treatment to Mesothelioma patients.

  • Neoadjuvant Chemotherapy – is an IV treatment that makes tumors more accessible for surgeons to remove by shrinking these tumors before surgery.
  • Intraoperative Chemotherapy – is the treatment option that requires a heated pump device to warm up the chemotherapy and treat the cancer cells directly in a local area during surgery.
  • Adjuvant Chemotherapy – is another systemic IV treatment that is administered after the surgery in order to prevent the cancer from growing again or recurring in the same area.

The Systemic or IV chemotherapy treatment is widely accessible at hospitals and various medical facilities, while the intraoperative chemotherapy is only available at top cancer centers.

In order to cause blood vessels to expand and increase the effectiveness of the treatment, chemotherapy drugs are heated before administering during surgery. The combining of intraperitoneal chemotherapy with surgery has proven to be the most successful approach for extending survival in peritoneal mesothelioma patients.

Chemotherapy Treatment – What to Expect

Based on the cancer type and stage of the disease, an oncologist will usually determine the appropriate chemotherapy drugs, frequency and dosage. At regular intervals called cycles, doctors usually prescribe the chemotherapy.

Treatment cycles are usually 2 – 4 weeks for mesothelioma patients. These breaks in treatment helps allow the healthy cells time to recover from the effects of the chemotherapy.

Depending on the response to treatment displayed by the body system of a patient, the chemotherapy schedule may change. If one’s body system begins to develop disturbing side effects, the doctor may have to recommend a delay or skipping of a cycle of treatment.

The Process involved in Chemotherapy

Although the procedure of chemotherapy treatment differs in different patients with the mesothelioma, here is a typical illustration of what to expect as you progress from first consultation till the end of treatment.

1. Consultation

The decision to undergo the chemotherapy should be discussed with you medical team and your family. Make sure that your mesothelioma tests and blood work have been reviewed by an experienced specialist, and also be sure to ask your doctor enough questions to make sure that you fully understand the cons and pros of chemotherapy.

2. Preparation

In order to reduce the side effects of chemotherapy, doctors often prescribe the drugs ahead of time. Before receiving systemic chemotherapy, many patients will need to have a catheter, pump or port inserted into a large vein. A patient may also need to visit a dentist to check for signs of disease that could interfere with the chemotherapy.

Eat a light meal before the treatment begins and also drink plenty of liquids to avoid dehydration. Make adequate plan for a ride to and from the treatment sessions, and get enough sleep in order to arrive well rested for the treatment.

3. Treatment

Doctors usually start by administering three or four cycles of mesothelioma chemotherapy approximately every three weeks. A nurse will then supervise each treatment after taking your vitals and verifying the dosage. Typically, the treatment includes 30 minutes of one drug and then up to about two hours of the second drug.

If during treatment you experience any side effects, discuss with you oncologist on how best to manage them. In order to ease side effects of treatments during any of the treatment cycles, you may need a prescription for medication. Always seek the help of friend and family at home or at work. You may need their assistance for daily duties, due to the extreme fatigue that often follows chemotherapy treatment.

4. Post-Treatment

A few weeks after you have completed the full regimen of treatment, follow-up visits will begin. At this point, you can ask more questions, get more insight about the treatment and how you feel, discuss the success or failure of the treatment and whether there is need for more treatments. Also feel free to bring a family member along to take part in these discussions.

Preparing for a Chemotherapy

Not knowing how you will react to the medication for your first ever chemotherapy can be frightening, it is usually unlikely for patients to feel prepared for the very first chemotherapy session. Making a plan and gathering your thoughts beforehand is a great way to prevent any feeling of getting overwhelmed during the first visit.

In preparation for chemo, there is usually no right or wrong way. It’s okay to seek advice from friends and family. The medical staff at your treatment center is also available for you if you need answers or more explanations about some of the processes that appears unclear to you. To also help you feel prepared and confident, you may go ahead to do some research on your chemotherapy drugs beforehand.

Having more insight about the chemo process can also prepare you for the treatment:

  • Preliminary Testing: In order to ensure that your body can withstand chemotherapy, you will usually be required to undergo heart and blood tests.
  • Port Placement: The systemic chemotherapy must be administered through a pump, port or catheter surgically placed into a large vein.
  • Dental Checkup: You may need to visit a dentist to check for any signs of infection. The risk of complications during chemo is usually reduced with a proper treatment of any dental infections.
  • Expect Side Effects: you should make sure to discuss how to manage any possible side effects with your oncologist. Before you begin treatment, you may need to pick up prescriptions that help to treat side effects.
  • Seek Assistance: Seek for assistance at home and work from friends and family. You may need their assistance for daily duties, due to the extreme fatigue that often follows chemotherapy treatment.
  • Getting Ready for Treatment: Eat a light meal before the treatment begins, and also drink plenty of liquid to avoid dehydration. Make adequate plan for a ride to and from the treatment sessions, and get enough sleep in order to arrive well rested for the treatment.

Drugs for Mesothelioma Chemotherapy

Several chemotherapy drugs for treating mesothelioma have been tested or currently being used by Mesothelioma doctors. Individual chemo drugs for mesothelioma act in different ways in different patients, and each of them have drawbacks and benefits.

There are chemo drugs that are designed especially for first-line treatment, and patients with new diagnosis usually get those. They work best in patients with no prior therapy for cancer. Meanwhile, patients with recurring cancer get to receive a different chemotherapy medication.

Cisplatin and pemetrexed, which has a brand name called Alimta, is the most common combination of chemo medication for mesothelioma treatment. Research has shown that for first-line chemotherapy treatment of mesothelioma, this is the best choice.

Some of the most common drugs for chemotherapy are:

  • Pemetrexed (Alimta)
  • Cisplatin
  • Carboplatin
  • Gemcitabine (Gemzar)
  • Cyclophosphamide
  • Vinorelbine
  • Raltitrexed
  • Doxorubicin

Compared to just one drug, clinical trials show that tumors respond better to a combination of two chemo drugs for medication. Mesothelioma chemotherapy almost always only involves two drugs, since adding a third drug has not proven to be more effective.

During intraoperative heated chemo, the drug combinations used for first-line and second-line are also very effective. For Hyperthermic Intraperitoneal Chemotherapy (HIPEC), more research has been done on the different drugs used, compared to Hyperthermic Intrathorcic Chemotherapy (HITHOC). Research on drugs for HITHOC is limited to just doxorubicin, cisplatin and mitomycin, but nearly all the drugs for HIPEC have been tested.

Heated Drugs for Mesothelioma Chemotherapy

Some samples of these common heated intraoperative drugs for chemotherapy include:

  • Pemetrexed (Alimta)
  • Doxorubicin
  • Mitomycin C
  • Cisplatin
  • Carboplatin
  • Paclitaxel
  • Gemcitabine

The doctor in charge may decide to choose other chemotherapy drugs or combinations depending on the medical history, allergies or cell type of the cancer.

Your doctor may also prescribe different drug combinations for another regimen, called second-line chemotherapy, if the cancer starts to grow again after you have completed first-line treatment. These new drugs combination may include gemcitabine with cisplatin, or Alimta.

Drugs for Mesothelioma Fist-Line Chemotherapy

Based on decades of research, the most effective drugs for mesothelioma are delivered in the first-line chemotherapy. For Pleural Mesothelioma, the first-line chemotherapy is usually a combination of pemetrexed and cisplatin. If the patient is seen to have certain health conditions, the doctor may use other medications.

For patients with inoperable pleural mesothelioma, the first-line treatment regimen will likely continue to be the pemetrexed/cisplatin combination. This is according to a study at the Shizuoka Cancer Center and Juntendo University in Japan back in the year 2014.

Drugs for Second-Line Chemotherapy

Doctors may prescribe second-line chemotherapy if the first-line chemotherapy fails to demonstrate positive results. A similar approach to the initial treatment or a completely different combination of medications may be administered in the second-line chemotherapy.

To reduce the toxicity for patients, sometimes a second-line drug may be substituted for one of the standard drugs for mesothelioma that was used in the first-line chemotherapy. Doxorubicin or gemcitabine may be substituted for pemetrexed and carboplatin may be substituted for cisplatin.

Chemotherapy Side Effects

Chemotherapy carries several side effects, although it is the most effective option for treatment and killing of mesothelioma cancer cells. Patients should try as much as possible to monitor their health for any signs of adverse reactions.

Although one may be able to manage simple side effects like vomiting and nausea with over-the-counter solutions, you might require a prescription or consultation with a specialist for more severe reactions like diarrhea or mouth sores.

You may also need to request a referral to a palliative care specialist from your oncologist. When it comes to managing side effects and controlling symptoms of cancer, these palliative care specialists are experts.

3 Major Tips for Side Effects Management

  1. B12 and folic acid levels are lowered with pemetrexed. Supplements may help prevent side effects and keep levels regular when you ask your doctor for them.
  2. Try keeping a journal for recording any changing of new side effects as you experience them. Record the intensity, date and any solution that helps.
  3. Do not try to be tough when experiencing any side effects for fear of missing a chemotherapy cycle. When it comes to tolerating long-term chemotherapy and preventing complications, overall health is vital.

The risks of side effects and the benefits of mesothelioma chemotherapy are different for each individual patient. Be mindful of how the chemo treatment impacts your life and how well you are tolerating it as you go through the treatment. Your mesothelioma doctor usually will always adjust the therapy to your specific needs.

Some of the major typical side effects of the mesothelioma chemotherapy are:

  • Fatigue
  • Vomiting and Nausea
  • Constipation and Diarrhea
  • Mouth sores
  • Hair loss
  • Chemo brain (forgetfulness, foggy thoughts or other forms of impairments)
  • Low blood counts

Rare Side Effects of Chemotherapy

Most specific side effects of chemotherapy for mesothelioma are more severe and require careful monitoring, although they are rare. Adverse reaction to medication or an infection can be indicated by these symptoms. If you happen to experience any of these symptoms after chemotherapy, do well to consult your doctor:

  • Unexplained bruising
  • Shortness of breath
  • Intense headaches
  • Bloody stool or urine
  • Fever higher than 100.5 F

Patients are encouraged to report to the United States Food and Drug Administration if they experience any severe problems from their chemotherapy. To help researchers develop better and safer treatments in the future, Cancer centers can help patients file a report to the FDA website.

Common Questions that People Ask about Mesothelioma Chemotherapy

Q: For Pleural and Peritoneal Mesothelioma patients, is the chemotherapy really effective?

A: Studies have proven that a combination of chemotherapy with another modality is the most effective treatment for all forms of mesothelioma. The combination of chemotherapy drugs cisplatin and pemetrexed (Alimta) in the pleural mesothelioma, when given after surgery, has helped in many cases to extend survival in patients. Patients, who are eligible for surgery in the peritoneal mesothelioma cases, usually undergo an application of heated chemotherapy during the surgical operation.

Q: What is the impact of chemotherapy on the life expectancy of Mesothelioma patients?

A: Overall health, eligibility for treatment, and diagnosis of the patient are the major factors that affect the life expectancy of a patient with mesothelioma. In 2019, a study showed that patients who received chemotherapy alone survived about an average of 9.5 months. Meanwhile for patients who received a combination of chemotherapy and surgery, the median survival was 12.2 months. Note that, research shows that the median life expectancy without any surgery is 7 months.

Q: How long is the Mesothelioma Chemotherapy?

A: The chemotherapy for mesothelioma patients are administered once in every 21 days, or every three to four weeks. Six doses are usually include for first-line chemotherapy, which means in may generally take more than four months to complete treatment by means of chemotherapy.

Q: Why are there side effects to the chemotherapy treatments?

A: Cells that multiply or replicate themselves are being killed by chemotherapy, which is a hallmark of cancer cells. Cells that make up the digestive tract, the hair and the mouth, are examples of other quickly replicating cells. These cells are targeted by chemotherapy, which is why it may usually cause side effects such as nausea, hair loss and mouth sores.

Q: Are there alternative mesothelioma treatment options to use rather than chemotherapy?

A: besides chemotherapy, other mesothelioma treatments include Tumor Treating Fields, clinical trials, radiation therapy and surgery. Supplementary care such as nutritional counseling, yoga and massage therapy, are options that some patients choose to go with. These can help improve the outcome of conventional treatments and also improve symptoms.

Q: Is it worth it to undergo chemotherapy?

A: for patients living with the mesothelioma and their loved ones, chemotherapy can be a very long and challenging process to go through. However, countless of stories of the fulfilling lifestyle led, that mesothelioma survivors share across the nation, with the extra time that the chemotherapy process has allowed them is most likely enough proof as to whether or not the process is worth it.

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