Mesothelioma and Chemotherapy

Chemotherapy in malignant mesothelioma is targeted towards patients who are not good candidates for surgery. Chemotherapy is mainly used to inhibit the growth or spread of cancer. Its use varies in different situations, and can be used as neoadjuvant, adjuvant or palliative in relation to the time of surgery or other treatment.

neoadjuvant chemotherapy refers to the use of chemotherapy before using other treatments, usually surgery. This strategy is used to help in shrinking the size of the tumor, so the level of success of any successful treatment will be higher. Chemotherapy can also be used after surgery. If used this way, is called adjuvant chemotherapy. It usually aims to eliminate microscopic residual disease. Finally, if chemotherapy is used to relieve certain symptoms in a patient, is referred to as palliative chemotherapy. It is reserved for patients with more advanced stages of malignant mesothelioma.

Combination chemotherapy drugs that have been approved by the Food and Drug Administration (FDA) is ALIMTA (pemetrexed) and Cisplatin. This combination is the first chemotherapy regimen for malignant pleural mesothelioma who have been approved by the FDA, and now the first line of treatment. This combination has been shown to prolong survival time of patients with an average of 3 months compared with a treatment regimen using cisplatin alone.

Before starting treatment with a combination / ALIMTA Cisplatin, patients are required to start supplementation with vitamin B12 and folate. Vitamin B12 should be given intramuscularly one week before treatment and repeated every 9 weeks during treatment. Folate is to be taken orally every day starting at the same time with vitamin B12 injections and continued until 21 days after the last cycle of ALIMTA. An oral steroid medication is also given to minimize the associated skin rash.

Schedule cycle of treatment with ALIMTA / cisplatin combination is every 21 days. Treatment consisted of 10-minute IV infusion followed by infusion of ALIMTA 2 hours Cisplatin. The number of cycles is given depends on the response of each patient and side effect profile. Typically, 3 to 4 cycles given before the patients were evaluated for response to treatment. If after evaluation, a satisfactory response to treatment were collected, a set of criteria used to decide whether or not chemotherapy should be continued. These criteria include looking for evidence of tumor shrinkage, stable disease, or continuous improvement. If the tumors shrink or remain stable disease with treatment, then chemotherapy may be continued as long as patients can tolerate. If the progression of the disease is a response to treatment, then chemotherapy should be stopped. Management of patients should now be directed at other options, namely, the possibility of palliative or hospice care.

Side effects to be expected is the same with chemotherapeutic drugs, and usually include nausea, vomiting, fatigue, and immunosuppression and increased susceptibility to common infectious agents.

Appropriate chemotherapy schedule should be adjusted for each patient. important factor to consider in coming to this schedule include the patient's response and tolerance profile of regimens. If it is determined that chemotherapy is not effective for certain patients, then other treatment options should be explored without hesitation.