Pleural mesothelioma is a rare and aggressive cancer that develops in the pleura, the protective lining of the lungs and chest cavity. This disease is primarily linked to asbestos exposure, with symptoms often appearing decades after initial contact. Chemotherapy serves as a primary treatment option for individuals with pleural mesothelioma, aiming to slow disease progression, reduce tumor size, and manage associated symptoms.
Understanding Pleural Mesothelioma and Chemotherapy’s Role
Pleural mesothelioma originates from mesothelial cells, which form the thin membranes surrounding the lungs and lining the chest wall. Inhaled asbestos fibers can become lodged in these tissues, leading to inflammation and cellular changes over many years, eventually resulting in cancer. The disease can cause symptoms such as chest pain, shortness of breath, and fluid buildup around the lungs.
Chemotherapy is a systematic treatment using drugs to destroy cancer cells throughout the body. These drugs target rapidly dividing cells, a characteristic of cancer cells. Goals of chemotherapy in treating pleural mesothelioma include improving overall survival, controlling disease growth and spread, and alleviating symptoms like pain and difficulty breathing. For many patients, especially those not suitable for surgery, chemotherapy is a standard treatment.
Common Chemotherapy Drugs and Combinations
The most commonly used chemotherapy drugs for pleural mesothelioma are pemetrexed and a platinum-based drug, either cisplatin or carboplatin. This combination has been a standard first-line treatment for over fifteen years. Research has shown that using these drugs together can lead to improved outcomes compared to using a single drug.
Pemetrexed, an antifolate drug, interferes with cancer cell growth. Cisplatin and carboplatin are platinum-based drugs that damage cancer cell DNA, preventing replication. While cisplatin is widely used, carboplatin may be substituted, especially for patients who may not tolerate cisplatin’s side effects. Other drugs, such as raltitrexed (often combined with cisplatin), vinorelbine, and gemcitabine, may also be used, particularly if mesothelioma returns or as second-line options.
How Chemotherapy is Administered and What to Expect
Chemotherapy for pleural mesothelioma is administered intravenously, with drugs delivered directly into a vein through a thin tube or cannula. This allows medications to circulate throughout the body. Some patients may have a long-term line, such as a central line, PICC line, or portacath, inserted into a large vein in the chest for easier and consistent access during treatment.
Treatment is given in cycles, consisting of a treatment period followed by a rest period. A common cycle length is every three weeks, allowing healthy cells to recover before the next dose. Patients receive up to six cycles, though the exact number and duration vary based on individual response and tolerance.
Common side effects associated with chemotherapy for mesothelioma can include nausea, fatigue, hair thinning, loss of appetite, and changes in blood counts. Low blood cell counts, affecting both red and white blood cells, can increase the risk of infection or anemia. Supportive care measures are employed to manage these side effects, such as anti-nausea medications, dietary advice, and sometimes growth factors to help boost blood cell production.
Chemotherapy in a Multimodal Treatment Approach
Chemotherapy is an integral part of a multimodal treatment strategy for pleural mesothelioma. This approach often combines chemotherapy with other therapies like surgery and radiation therapy. The aim is to enhance treatment effectiveness and improve patient outcomes.
For instance, chemotherapy may be given before surgery (neoadjuvant chemotherapy) to shrink tumors and make them more manageable for removal. Following surgery, adjuvant chemotherapy may be administered to eliminate any remaining cancer cells and reduce recurrence risk. Radiation therapy can also be used alongside chemotherapy, sometimes to target specific tumor areas or for palliative purposes to control pain. Emerging therapies and clinical trials also integrate chemotherapy, providing access to new treatments and advancing mesothelioma care.