Chemotherapy
Mesothelioma is very difficult to treat. Usually by the time it is diagnosed, it has already spread locally, and into many adjacent tissues. A pleural mesothelioma may have spread all around the pleura on the side of the tumor, both the visceral and parietal pleura, resulting in pain and shortness of breath, often because of a large effusion on the side of the tumor. It will usually also have invaded the lung, the chest wall itself, and the diaphragm.
Patients with mesothelioma often have other health problems. With the long latency period of 30 or more years between exposure and onset of the disease, many patients are in their sixties or seventies. If they smoke, they may have other lung diseases. Or they may have coronary heart disease, diabetes, or any of the many health problems common to older adults.
Between the spread of the cancer and the health status of the patient, surgery is often not an option. Or perhaps it will be a part of the treatment, for example, removing fluid from the pleural space and putting an irritant in to close the space. That would be palliative surgery aiming at making the person more comfortable and decreasing the patient’s pain.
In the last 5 to 10 years, great progress has been made in chemotherapy of mesothelioma. Single agent chemotherapy has not been very successful, but treatment with two chemotherapeutic agents helps patients live longer and with less symptoms.
At the current time, the two-agent regimen of pemetrexed (Alimta) and cisplatin has been FDA-approved and is really the treatment of choice for mesothelioma that cannot be treated surgically. Many other single and double agent treatment protocols are under study, and there may be more ways to treat mesothelioma in the future. For patients with mesothelioma in Stages 2 or 3, the two-agent chemotherapy is a reasonable choice. However, for some patients, especially for patients in Stage 4, clinical trials may provide alternatives that turn out to be more effective.
Chemotherapy is not just the first treatment for many patients. It may be employed with surgical procedures to help kill more mesothelioma cells. Or, there may be progress with one chemotherapy regimen, and then there may be a worsening of the tumor, and the necessity of employing second and different chemotherapeutic agents.
All chemotherapy agents attack cells that are growing and dividing rapidly, first and foremost, the cancer. There are other cells in the body that are dividing rapidly, including the cells lining the intestinal tract and mouth, the bone marrow which produces blood cells, and hair follicles. Consequently, there are some common side effects involved with almost any chemotherapy. These include, among other things, nausea and vomiting, diarrhea and decreased appetite, fever, fatigue, rashes, and decreased blood cells, including white blood cells, red blood cells, and platelets. There are often laboratory abnormalities demonstrating damage to the liver or kidneys. Many of the side effects can be treated or minimized by following certain protocols and using other medication. That does not mean that patients do not have side effects, but that they can be made more comfortable.
Dr. Kaplan