Mesothelioma is a cancer that forms in the thin layer of tissue covering the lungs, chest wall, abdomen, or heart. It is most often caused by exposure to asbestos, a group of minerals once widely used in construction, shipbuilding, and manufacturing. In Missouri, past asbestos exposure occurred in workplaces such as lead smelters, power plants, railroad yards, and older industrial buildings, particularly in St. Louis, Kansas City, and along the Mississippi River. Chemotherapy is one of the standard treatments for mesothelioma and is often combined with surgery or radiation.
How Chemotherapy Works for Mesothelioma
Chemotherapy uses drugs to kill cancer cells or stop them from dividing. Because mesothelioma cells tend to grow quickly, chemotherapy drugs target rapidly dividing cells throughout the body. This makes chemotherapy a systemic treatment, meaning it can reach cancer cells that have spread beyond the original tumor site. Chemotherapy is commonly used to shrink tumors before surgery, to destroy remaining cancer cells after surgery, or as the main treatment when surgery is not an option.
Types of Chemotherapy Drugs Used for Mesothelioma
Several chemotherapy drugs are used to treat mesothelioma, either alone or in combination. The most widely studied and commonly prescribed combination is cisplatin or carboplatin with pemetrexed.
- Pemetrexed (Alimta): An antifolate drug that blocks enzymes cancer cells need to grow. It is the most frequently used drug for pleural mesothelioma and is almost always given with a platinum-based drug. Patients taking pemetrexed are also given folic acid and vitamin B12 supplements to reduce side effects.
- Cisplatin: A platinum-based drug that damages the DNA of cancer cells, causing them to die. It has been used for decades and is considered a backbone of mesothelioma treatment.
- Carboplatin: A platinum-based drug similar to cisplatin but often with fewer side effects such as nausea and kidney problems. It may be used for patients who cannot tolerate cisplatin.
- Gemcitabine: A nucleoside analog that interferes with DNA production in cancer cells. It is sometimes used in combination with cisplatin or as a second-line treatment when the first regimen stops working.
- Vinorelbine: A plant-derived drug that disrupts cell division. It is occasionally used alone or with other drugs for patients who do not respond to standard treatment.
- Doxorubicin: An anthracycline antibiotic that has shown limited activity against mesothelioma and is less commonly used today, but it may be considered in certain situations.
How Chemotherapy Is Given
Chemotherapy for mesothelioma is usually delivered intravenously in an outpatient clinic or hospital infusion center. Treatment is given in cycles, with a period of treatment followed by a rest period to allow the body to recover. A typical cycle lasts three to four weeks, and the total number of cycles depends on the stage of the disease and how well the patient responds. In some cases, chemotherapy may be delivered directly into the chest or abdominal cavity during or after surgery, a technique called heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma.
Chemotherapy Treatment in Missouri
Missouri residents diagnosed with mesothelioma can receive chemotherapy at major cancer centers across the state. Comprehensive treatment programs are available at institutions in St. Louis and Kansas City, as well as at regional hospitals in Springfield, Columbia, and other communities. Patients should discuss their treatment plan with an oncologist who has experience with mesothelioma, as the disease is relatively rare and requires specialized care. Travel to a larger center may be necessary for access to clinical trials or advanced surgical programs.
Combining Chemotherapy with Other Treatments
Chemotherapy is often part of a multimodal approach that includes surgery and radiation therapy. For pleural mesothelioma, a common plan is chemotherapy before surgery to shrink the tumor, followed by surgery and possibly radiation. For peritoneal mesothelioma, chemotherapy may be heated and circulated through the abdomen during surgery. The specific combination depends on the cancer stage, the patient's overall health, and the tumor location.
Chemotherapy remains a central part of mesothelioma care. Understanding the types of drugs available and how they are used can help patients and families have more informed conversations with their medical team. Every treatment plan is individualized, and patients should ask their oncologist about the expected benefits, potential side effects, and any available clinical trials.
