Chemotherapy Treatment for Mesothelioma
Receiving the diagnosis of mesothelioma usually means the start of extensive medical treatments to halt the progression of the disease. It often means obtaining one or more of the standard methods of cancer responses: surgery, radiation, or chemotherapy. For information about other types of mesothelioma treatment, please see “Mesothelioma Treatment Overview.”
In many cases, the primary treatment is chemotherapy, since it can improve the outcome of surgery as well as radiation. It does this in a number of ways: First, since the varied chemotherapy drugs work on the basis of either destroying cancerous cells or preventing them from multiplying or spreading, it can allow a malignant tumor to shrink prior to surgery, which may make the operation easier and safer. It could also kill any remaining, microscopic cells that may remain in the body after a cancerous growth is removed. Chemotherapy may also stop a regression of the condition, keep it from spreading, and alleviate some of the pain. The majority of doctors prescribe a mix of treatments to maximize a patient’s chance for success and prolonged life.
In the case of patients whose physical condition makes them poor candidates for surgery, chemotherapy then becomes their primary treatment. Just as with any cancer treatment, mesothelioma care demands drugs that are tolerable to a patient, and, fortunately, there is an array from which physicians may choose. There are several recommended combinations as well as individual drugs that have been found to be effective, and one in particular was approved by the Food and Drug Administration specifically for mesothelioma. Currently, scientists and researchers are working with the medical community on many other drugs that may be beneficial in the fight against this particular cancer.
Chemotherapy Treatment Concerns
However, like other chemotherapy drugs, those for mesothelioma can cause the same undesired side effects. They are unavoidable due to the nature of the drugs whose mission is to demolish the bad cells; unfortunately, good ones get killed as well. Although most of the body’s cells do not reproduce as rapidly as those which are malignant, some cells in the body have a higher than average rate. This includes those found in the digestive tract (mouth, esophagus, stomach and intestine), the reproductive system, and hair follicles. This is why so many chemotherapy patients suffer from nausea, vomiting, diarrhea, constipation, and mouth sores, and the loss of appetite and hair. Some cells in major organs such as the heart, lungs, kidney, and bladder or liver may be affected, and cell changes in bone marrow can cause conditions ranging from fatigue to heavy bleeding from small injuries, to a jeopardized immune system. Even numbness and tingling of the extremities, or ringing in the ears, may occur. Patients are advised to report all side effects to their physician, no matter how minor. They are also told to refrain from taking any over the counter medicine or prescription unless discussed first with the doctor, as any such product may have an adverse affect on the chemotherapy treatment.
Physicians understand that the most important part of chemotherapy is to get appropriate drugs into a patient as quickly as possible within a limited time frame, but with regard to drug toxicity and patient endurance. Therefore, great care is taken for the optimum dosage with minimum effects. If a patient should quit chemotherapy too soon due to side effects, what they’ve currently endured may not result in much overall benefit. Therefore, evaluations are constantly performed during the treatment cycles to determine how effective the drug combinations are in fighting the disease, while causing the least amount of physical duress. Most mesothelioma treatments consists of at least 3 chemotherapy visits to start becoming effective, and changes are made after 6-8 weeks. These alterations can be based on the patient’s age, overall health, type of drug, stage of disease, reactions to the drug, and goal of the chemotherapy. The side effects cease once chemotherapy is discontinued, which could be prior to surgery or when the disease appears stabilized. If the patient’s condition worsens, chemotherapy is usually discontinued and alterative treatments begun.
Some mesothelioma patients do not receive their infused chemotherapy drugs via an intravenous needle; some applications utilize a catheter directly into the chest or abdominal cavity. This places the medicine in immediate contact with the cancerous tumor, which can benefit the patient outcome. The normal procedure is done for 130 minutes every 21 days, and may be supplemented with other injections. During the course of treatment, patients should attempt to eat healthy food to avoid weight loss, drink a high volume of liquids, and avoid individuals with colds or the flu.
Chemotherapy Drugs
Currently, the optimum combination of chemotherapy drugs is pemetrexed (Alimta) and cisplatin. Alimta is the first approved chemotherapy drug specifically for mesothelioma; it is the first FDA approved treatment for malignant pleural mesothelioma and considered most effective treatment for mesothelioma patients who are not good candidates for surgery. Alimta inhibits thymidine and purine synthesis and thus blocks cell division. When used with cisplatin, alimta increases lifespan 3 months longer than when used alone, but must be used in conjunction with oral steroids, B12, and folic acid.
Another combination is cisplatin and gemcitabine, which have been two standard chemotherapy drugs. Patients using this regime report more weight gain and an improved respiratory function. The mix utilizes gemcitabine’s anti-metabolite, DNA-cessation properties with cisplatin’s poisonous effects. (However, patients experience reduced nausea and vomiting when taking cisplatin when mixed with carboplatin.) Cisplatin is also combined with the anti-cancer drug doxorubicin (as well as with a mixture of vinblastine and mitomycin). Other popular pairings are cisplatin with doxorubicin and cyclophosphamide, and vincristine with methotrexate. Non-poisonous drugs include raltitrexed, which interferes with the tumor cells’ ability to create DNA, onconase, which also interrupts protein synthesis, and vinorelbine, which blocks cell division. The medical community is conducting research on newer drugs such as paclitaxel, coramsine, and irinotecan, and the anti-angiogenesis agents of bevacizumab and endostatin to determine their abilities to treat mesothelioma.
Sources:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_29.asp?sitearea=
http://www.mesotheliomaweb.org/treat.htm
http://www.mesotheliomasite.com/treatment/treatment_chemotherapy.htm
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