Mesothelioma Treatment With ALIMTA and Other Drugs

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Mesothelioma Treatment

Mesothelioma Treatment: Chemotherapy and New Drug Research

Chemotherapy uses medicines, drugs and chemicals as a way to kill cancer cells. For mesothelioma patients, the results of chemotherapy have been mixed, yet there is now cause for hope as new drugs are discovered and made available.

Methods of Delivering Chemotherapy

Chemotherapy drugs may be given to patients in pill form or by injection into the vein or muscle. Chemotherapy is called a “systemic treatment” because the drug enters the bloodstream, travels through the body, and can kill mesothelioma cancer cells throughout the body. Drugs may be put directly into the chest (intrapleural chemotherapy) or into the abdominal cavity (intraperitoneal chemotherapy).

Chemotherapy Drugs Used for Mesothelioma Treatment

Chemotherapy may be used in combination with surgery to slow mesothelioma tumor growth. It is also used alone in more advanced mesothelioma cases when surgery is inappropriate.

Pemetrexed is the first chemotherapy drug approved to specifically treat pleural mesothelioma. It has prolonged patients’ survival and improved the quality of their lives. New drugs such as raltitrexed and ranpirnase are still in the experimental stage.

Pemetrexed (ALIMTA^®): A Promising Mesothelioma Treatment

In February, 2004, the U.S. Food and Drug Administration (FDA) approved the use of the chemotherapy drug pemetrexed (ALIMTA^®), combined with the standard platinum compound, cisplatin, to treat pleural mesothelioma. Many doctors hailed the new treatment as a breakthrough for mesothelioma patients.

Pemetrexed attacks cancer cells by inhibiting the synthesis of thymidine and purine, enzymes that are necessary for cell growth. Although it cannot cure mesothelioma, ALIMTA^® prolongs life and reduces pain. It can provide new hope if you have a more advanced case of pleural mesothelioma where surgery is not an option.

If you take pemetrexed, you may experience troublesome side effects. These include nausea, vomiting, diarrhea, fatigue, mouth sores, and lowered blood counts. However, taking vitamin B12 and folic acid may reduce some of these problems. The doctor will also prescribe a corticosteroid to reduce your chance of developing rashes. A corticosteroid is a steroid obtained from the cortex of the adrenal gland, or any synthetic substitute.

Raltitrexed (Tomudex^®)

Raltitrexed works by interfering with the ability of tumor cells to multiply and make deoxyribonucleic acid or DNA. One early–stage clinical study showed a positive response rate in mesothelioma patients of about 20% when raltitrexed was used alone (Eur J Cancer. 2003 Feb; 39(3): 353–7). Another study showed a similar response rate when raltitrexed was used with oxaliplatin, an anticancer drug that belongs to the family of platinum compounds (J Clin Oncol. 2003 Jan 15; 21(2): 349–54).

Ranpirnase or P–30 Protein (Onconase^®)

A ribonuclease isolated from the eggs of the leopard frog, Onconase^® interrupts protein synthesis and inhibits cancer cell growth. In a limited study of 105 patients treated with Onconase^®, the one–year and two–year survival rates were 34.3% and 21.6 %. This compares well with the usual survival rate of 6 to 8 months without treatment. More advanced clinical trials are underway looking at the effects on mesothelioma patients of Onconase^® combined with doxorubicin, a standard chemotherapy drug used to treat many other cancers (see Clinical Trials, National Institutes of Health).

Vinorelbine

Vinorelbine is a plant alkaloid that blocks cancer cell division. It has been used in the treatment of breast cancer and non–small cell lung cancer. Recently, vinorelbine was studied in clinical trials of mesothelioma patients (Journal of Clinical Oncology, Vol 18, Issue 23 (December), 2000: 3912–3917). The drug reduced pain and improved the quality of life for some some patients and had a relatively low toxicity and mild side effects. Further research will be done to determine the effects of combining vinorelbine with other chemotherapy agents.

Platinum Compounds and Anti–Metabolites

The platinum contained in the compounds cisplatin, carboplatin, and oxaliplatin acts as a poison for cancer cells. Both cisplatin and carboplatin are used to treat lung cancer; oxaliplatin is often used to treat colorectal cancer. Mesothelioma patients may show some improvement with the use of these compounds alone, but the results are inconsistent.

Combining the platinum compound cisplatin with the drug pemetrexed is now an approved mesothelioma treatment. See Pemetrexed (ALIMTA^®): A Promising Mesothelioma Treatment.

Researchers are considering other combinations of newer drugs plus platinum compounds. In a multicenter clinical trial, 26% of mesothelioma patients who took a combination of cisplatin and the chemotherapy drug gemcitabine showed improved breathing, weight gain, and pain reduction (Cancer. 2003 Jun 1; 97(11): 2791–7). Gemcitabine is an anti–metabolite that works by stopping cancer cells from making or repairing deoxyribonucleic acid or DNA, the cell’s genetic material. No doubt, further studies will be done to determine the benefit of cisplatin/gemcitabine therapy in mesothelioma patients.

Side Effects of Chemotherapy for Mesothelioma Patients

Most chemotherapy drugs cause fatigue or even exhaustion. Other side effects may include nausea, vomiting, and hair loss.

Specific side effects will depend upon the drug that you are using, its dosage, and the length of your treatment. You will need to consult your doctor both before and after the chemotherapy treatment to know what side effects you may expect and how to minimize these. For more details, see our discussion Mesothelioma Treatment: Side Effects of Chemotherapy.