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There are some types of mesothelioma treatment including chemotherapy.
Chemotherapy is one of the most common and widely recognized forms of cancer treatment. Chemo is a form of treatment that utilizes powerful chemical substances to kill malignant tumor cells. Unfortunately, chemotherapy cannot differentiate between cancerous and healthy cells, leading to some serious side effects.
Chemo is most often employed as a treatment for Mesothelioma patients when they are not candidates for surgical treatments. Current chemotherapy treatments for Mesothelioma patients use a combination of Alimta (pemetrexed) and Cisplatin. Alimta is the first FDA drug specifically approved for treatment in Mesothelioma patients.
In addition to the chemotherapy chemicals, it is often recommended that patients take vitamin B12 injections and folic acid in concert with their chemotherapy treatments in order to mitigate the harmful side effects of the drugs. The chemo drugs are typically administered every 21 days. Be sure to discuss the potential side effects and any other medications you are taking with your health care professional.
Most of the available chemotherapeutic agents have been tried in mesothelioma but none has consistently produced a response rate above 20%. Agents which have consistently been reported to produce response rates of 10-20% include doxorubicin, epirubicin, mitomycin, cyclophosphamide, ifosfamide, cisplatin, carboplatin, and antifolates. Combination chemotherapy trials have not demonstrated consistently greater response rates than single agent trials.
There are no published randomised studies which show improved survival in patients treated with chemotherapy compared with supportive care. Symptomatic improvement has been reported following chemotherapy, both in patients with and those without demonstrable tumour regression. However, no randomised studies have compared the effects of chemotherapy and best supportive care on symptoms and quality of life.
There is a need to continue to explore new agents and new approaches in phase I and II trials and to evaluate regimes which appear to show activity in larger randomised trials. Comparison of different chemotherapy regimens and comparison of chemotherapy with best supportive care would be appropriate, particularly in patients with few symptoms. End points should include tumour response as assessed by serial CT scans, quality of life, and survival.
The proposed BTS/MRC trial compares active symptom control (ASC) with ASC and either three agents (mitomycin, vinblastine and cisplatin) or a single agent (navelbine). All patients should be offered the opportunity to discuss what chemotherapy may offer with an oncologist or respiratory specialist with an interest in management of mesothelioma as part of their multidisciplinary care. For those who wish to have chemotherapy it is reasonable that it should be offered, preferably within the context of a clinical trial.
It has been a major challenge for doctors to find chemotherapy drugs that work well in treating malignant mesothelioma. Many trials have been done using epirubicin, doxorubicin, cisplatin and methotrexate, but no standard treatment has been set. This has led researchers to look at newer chemotherapy drugs in combination with some already tried.
Most studies giving gemcitabine alone have not been successful. A small number of trials using gemcitabine in combination with cisplatin, have produced some promising results. Many doctors now use this combination of drugs to treat malignant mesothelioma. But more trials are needed before it may be considered as standard treatment.
In one study 29 patients were given vinorelbine alone, 6 (24%) patients disease improved and 16 (55%) patients disease remained stable. This has led to further trials using this drug. A trial called MS-01 opened in 2003. It is comparing active symptom control (ASC) with ASC and vinorelbine and with ASC, mitomycin, vinblastine and cisplatin. You can find this on our clinical trials database by clicking on the clinical trials button to the left of your screen. Select Lung: mesothelioma from the drop down menu. Click these links for information about the side effects of vinorelbine, cisplatin, mitomycin C and vinblastine.
Topotecan and irinotecan have not shown significant responses when given by themselves. But in combination with other drugs, there have been some good results. A trial has been done looking at irinotecan, cisplatin and mitomycin C (IPM). This trial closed in Feb 2004 and the results will be available soon.
Pemetrexed is a type of chemotherapy drug. It is also called Alimta. It is a little similar to another drug in regular use called methotrexate. It has been used in the largest phase 3 clinical trial ever conducted for malignant pleural mesothelioma. This international trial began in 1998 and results were reported on in May 2002.
The study was aimed at finding out whether pemetrexed plus cisplatin was more effective in treating malignant mesothelioma than cisplatin alone. All patients were given supplements of vitamin B12 and folic acid to help reduce side effects (such as diarrhoea). The outcome of this trial was promising. A number of recent trials are now looking at the use of pemetrexed in combination with other chemotherapy agents.
In summary, chemotherapy is the use of medications to treat cancer. Chemotherapy cannot cure mesothelioma. Some chemotherapy drugs have a partial effect in some patients. Combination chemotherapy (using more than one drug at the same time) may be given in an attempt to improve the patient's response to the medications. Some combinations have shown promise, and some new medications are being tried.
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