Chemotherapy drug advancement that is specifically designed for mesothelioma is making advancement every day. The Food and Drug Administration has already approved one drug combination treatment for malignant pleural mesothelioma, and research is ongoing regarding new developments. Even though no chemotherapy drugs can cure any cancerous condition, they can stop the progressions of the disease, and by doing so, extend the patient's life.
Depending on the patient's age, health, and stage of mesothelioma, chemotherapy has one of four goals: stop the spread of cancer, reduce the size of a tumor, kill remaining cancerous cells after surgery, or relieve pain. Chemotherapy also enables radiation to work more effectively. However, even if it is the main treatment, chemotherapy often prohibits cancer's advancement. Although chemotherapy doesn't cure cancer, the treatment can provide long-term benefits.
Today, the preferred drug combination is pemetrexed (Alimta) and cisplatin. Alimta was approved by the Food and Drug Administration (FDA) as the first chemotherapy drug specifically for mesothelioma. It is considered the best treatment for mesothelioma patients who face surgical risk, by blocking cell division through thymidine and purine synthesis inhibition. The combination of both drugs has been found to increase lifespan 3 months longer than when using alimta alone. The course of treatment consists of a 130 minute infusion every 3 weeks while taking oral steroids, B12, and folic acid. Evaluation is done after 3-4 cycles. Mesothelioma patients are sometimes given drugs directly, or intrapleurally, into the chest cavity or intraperitoneally into their abdominal cavity to target the tumor more effectively. Regardless of the type of drug, amount of dose, type of infusion, or the duration of treatment time, all patients receive ongoing evaluations to determine their response and the need for alterations. Every patient's reaction is different, and will have their own protocol. Every physician will attempt to make the experience tolerable, while attempting to halt the spread of disease as quickly as possible. Timing of cycles and cessation of treatment will be based upon the chemotherapy's goal, the cancer's stage and drug toxicity recuperation.
Mesothothelioma patients, however, still face the same risk of side effects as patients receiving chemotherapy for all other cancers. The reason these conditions occur is based on the fact that there are two forms of drugs utilized in chemotherapy: those that stop cell division and the spread of the disease, and those that kill cells in a method similar to poisoning. Unfortunately, drugs can't differentiate between good and bad cells, so in the process of eliminating malignancies, healthy cells are also injured or killed. When cells that are the most vulnerable are affected, the body has a fairly rapid reaction. The digestive tract is one such area with rapid cell turn-over, so patients on chemotherapy usually suffer a loss of appetite, nausea, vomiting, constipation, and diarrhea. Since hair follicles are vulnerable as well, there is hair loss. As the blood marrow is also affected, red or white blood cell loss leads to a host of problems. Reported conditions include fatigue, heavy bleeding from small wounds, compromised immune system, tingling, numbness and fever. Occasionally, there may even be side effects involving cell damage to the vital organs of lungs, heart, kidney, liver and bladder. All side effects disappear when chemotherapy ends, but all chemotherapy patients must report any side effect, no matter how minor, to their doctor. Not doing so could seriously jeopardize their treatment program. Progress may also be sabotaged in other ways; patients must not take any prescription or over the counter product without first discussing it with their doctor, and must eat healthy foods, drink adequate liquids and stay away from anyone highly contagious with cold or flu germs. Such practice strengthens the body in its fight against cancer through chemotherapy, and the effects of chemotherapy itself.
Additional Chemotherapy Drug Combinations
In addition to the above mixture of cisplatin and alimta, other drug combinations are used for mesothelioma chemotherapy:
- Cisplatin and Gemcitabine -Patients experience less pain, more weight gain and improved respiratory function. Gemcitabine's anti-metabolite properties halt DNA production and repair while cisplatin kills the cells.
- Cisplatin and carboplatin-This is another poisonous compound but causes less nausea and vomiting.
- Cisplatin and doxorubicin, possibly with cyclophosphamide
- Cisplatin, vinblastine and mitomycin
- Vincristine and methotrexate
Some drugs do not poison the cells, but prevent reproduction:
- Raltitrexed interferes with the tumor cells' ability to create DNA
- Onconase also interrupts protein synthesis
- Vinorelbine blocks cell division
Many mesothelioma chemotherapy drugs can be effective when used alone by people who can't tolerate multiple drugs. Current studies are being conducted regarding new combinations and recently engineered drugs, as well as new applications of platinum compounds. Drugs such as irinotecan, paclitaxel, and coramsine are under investigation, and the anti-angiogenesis agents of bevacizumab and endostatin are being considered as possible weapons in the battle against mesothelioma.