Chemotherapy treats cancer with drugs that destroy malignant cells. It may be used to shrink a tumor before surgery (neo-adjuvant therapy), to help destroy cancer cells that may remain after surgery (adjuvant chemotherapy), to make radiation therapy or immunotherapy work more effectively, or to help destroy cancer that recurs or has spread from the site of the original tumor. It may also be used as a stand-alone treatment in cases where the patient is not a surgical candidate.
Scientists are continually developing new chemotherapy agents and regimens for cancer patients; ask your oncologist if they are appropriate for you. A recent article in the journal Expert Opinion on Pharmacotherapy stated "there has been definite progress in the systemic treatment of this disease within the past 5 years". In addition to standby drugs such as cisplatin, gemcitabine, and Alimta, anti-angiogenesis agents such as bevacizumab and endostatin are being vigorously pursued by researchers. Ranpirnase (onconase) is also promising as is coramsine.
Chemotherapy drugs may be given as single agents, but often, two or more drugs are given simultaneously. This is called "combination therapy". Such is the case in mesothelioma chemotherapy when Alimta is combined with drugs such as cisplatin or gemcitabine. According to Dr. Petr F. Hausner, "other novel chemotherapy combinations are promising e.g. raltitrexed (Tomudex) with oxaliplatin (Fizazi, Doubre et al. 2003)."
The most promising drug for mesothelioma is pemetrexed, an inhibitor of a number of proteins, including thymidylate synthase and dihydrofolate reductase, both of which are required for DNA synthesis. Pemetrexed, marketed under the trade name Alimta, is in the antifolate class of chemotherapy agents.
| Category | Cell Reproductive Phase Involved | Examples |
| Alkylating | Non-specific | Cisplatin |
| Anthracyclines | Non-specific | Doxorubicin |
| Taxanes | Mitosis | Paclitaxel |
| Antimetabolites | ||
| Antifolates | DNA Synthesis | Pemetrexed |
| Anti-purines | DNA Synthesis | Fludarabine |
| Anti-pyrimidines | DNA Synthesis | Gemcitabine |
According to material published by the National Comprehensive Cancer Network, oncologists typically choose from one of five options for first-line chemotherapy:
- Pemetrexed plus Cisplatin
- Pemetrexed plus Carboplatin
- Gemcitabine plus Cisplatin
- Pemetrexed (single agent)
- Vinorelbine (single agent)
Other Effects
Most anticancer drugs destroy cancer cells by preventing them from multiplying. Unfortunately, healthy cells can also be harmed, and it is the damage to the healthy cells causes undesirable side effects. The cells most likely to be affected are the fast-growing normal cells such as the blood cells forming in bone marrow, and cells in the digestive tract which includes the mouth, stomach, intestines, and esophagus. Hair follicles may also be affected, hence, hair loss during chemotherapy. Some drugs affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system.
Before beginning a chemotherapy protocol, your doctor should discuss your specific treatment and the side effects most closely associated with the drugs you will be receiving.
Questions you may wish to ask about your treatment are:
- How many treatments will I be given?
- What drug or combination of drugs will I receive?
- How will the drug/drugs be administered, i.e., pill, intravenous, etc.?
- Where will I go for my treatment, i.e., doctor's office, hospital, etc.?
- How long will each treatment last?
Questions you may wish to ask about side effects are:
- What side effects are associated with the drug/drugs I will be given?
- Which of these side effects are likely to occur?
- What can I do to relieve these side effects?
- Are there certain side effects I should report immediately?
- How can I contact a health professional after hours if I need to call?
Once chemotherapy is completed, normal (non-malignant) cells usually recover, so most side effects will gradually disappear after treatment ends. The amount of time it takes to get over side effects depends on many factors, including your overall health and the type of chemotherapy you have been receiving.
Ask your doctor for more information about these medications. Contact us if you need more ideas about what to ask your doctor or to learn about clinical trials using these drugs. (See also chemotherapy glossary and mesothelioma glossary.)
New chemotherapy agents and combinations of agents are generating improved results for mesothelioma patients. Scientists are excited about combination therapies and targeted therapies with agents such as kinase inhibitors and angiogenesis inhibitors. Read about new approaches in Malignant Mesothelioma: Focus on New Therapeutic Approaches, a summary of exciting new approaches in mesothelioma treatment.
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