Pleural Mesothelioma Chemotherapy Treatment

Chemotherapy in mesothelioma treatment is not curative. This is not meant to imply that chemotherapy is not without its palliative benefits. Studies have demonstrated that the most active regimen of chemotherapy as a part of pleural mesothelioma treatment can reduce tumors in 40% of patient and extend life in those that respond to chemotherapy. Chemotherapy has also been shown to palliate symptoms including reducing shortness of breath, reduction of ascites or effusions, reduction of pain and improvement has been noted in quality of life studies. Chemotherapy is also given as a neo adjuvant treatment (prior to a planned surgical intervention) post-surgery (adjuvant therapy) or as a single modality. In some cases patient who have been considered inoperable can become surgical candidates following administration of chemotherapy.

In addition to questions about the types of available chemotherapy treatments, other common questions surrounding the use of chemotherapy in mesothelioma treatment include:

Systematic and Regional Chemotherapy Treatment

Some chemotherapy is cytotoxic which means that it is capable of killing malignant cells. Other pleural mesothelioma chemotherapy treatments are cytostatic, which means that they can inhibit cellular activity or cellular multiplication. We now use a new term “targeted” therapy or “smart” drugs which refers to drugs that are specifically designed to act on genes that promote or suppress cancerous cells. Immunotherapy is a method of harnessing the body’s own immune system to activate and kill malignant cells. A thorough discussion will take place in a section titled ‘Standard and Investigational Therapies in Mesothelioma'.

The most effective alternative to systemic application is a regional or localized application, meaning the penetration of the drug can be administered directly to the affected area or organ, allowing it to reach levels much higher than through the systemic circulation. There are two variations to this technique of controlling the application of chemotherapy to specific surfaces:
  •  Direct application – Chemicals are applied directly to the area
  • Intra-cavitary application - A special shunt or tube is used to feed the chemicals directly into the pleural space.
Both of these techniques allow for a much higher concentration of chemicals to be achieved since most of the drug remains outside of the bloodstream, coating only the exposed tissue surfaces.

Some absorption of the chemo into the affected surfaces is necessary for it to work. For chemotherapy given in this manner during surgery, the surgeon will need to strip the tumor down to millimeters to ensure optional tissue penetration. Dosages of some of the drugs used in this manner have been determined by tissue penetration studies in mesothelioma and other cancers.

Which approach is used depends upon the goals of the mesothelioma treatmentand the need to control side effects. In any case, the application methods are carefully selected and should be made available only in a clinical trial setting. Experienced mesothelioma centers are the best suited to advise on the benefits vs. the risks of these procedures as well as the experience to minimize the risks adherent to the various protocols. EPP and PD are not standard of care but options to be considered during initial consultations.

The Mesothelioma Foundation is here to help the families and patients affected by mesothelioma. Contact our nurse practitioner for critical information about your diagnosis.

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