Researchers are still testing different combinations for treating mesothelioma.
A combination of alimta and cisplatin has remained the standard of care for years.
Side effects can vary greatly dependent on the combination of chemotherapy drugs.
The cost of chemotherapy is estimated to be even as much as $50,000 per course.
Researchers have conducted a variety of clinical trials testing different combinations and single-agent applications of chemotherapy drugs for mesothelioma. Below are some of the most commonly studied and used drugs in the treatment of mesothelioma. Clinical trials are ongoing for many to determine the most effective treatment combinations, as the response rates or efficacy of these drugs still varies widely among patients.
Dosage and frequency will vary based on an individual patient’s case and the doctor’s treatment plan. The course of treatment will also be influenced if these drugs are being implemented individually, as part of a multimodal treatment with either surgery or radiation therapy, or if they are being used in tandem with another chemotherapy drug. Chemotherapy may be used curatively in the hopes of achieving a partial response or complete response to extend survival, or these drugs may be applied palliatively to alleviate symptoms.
In general, these drugs are largely given intravenously or through an injection. Some, like cyclophosphamide, are also available in tablet form. Side effects may vary from person to person and may also depend on the drug or treatment combinations.
Generic Name: Pemetrexed
Manufacturer: Eli Lilly and Co.
Commonly Used With: Cisplatin
Alimta is the first and only chemotherapy drug to be approved by the U.S. Food and Drug Administration (FDA) to treat malignant pleural mesothelioma. When surgery is not an option for mesothelioma, Alimta is considered one of the most important treatment options for mesothelioma patients. Most often, Alimta is used in combination with cisplatin as a first-line therapy after a clinical trial showed pemetrexed plus Cisplatin extended the patients’ survival to about 12 months, compared to 9 months when treated with cisplatin on its own. Another clinical trial conducted between 2008 and 2014, found a median survival of 16 months for 225 patients treated with a combination of pemetrexed + Cisplatin.
Generic Name: Bevacizumab
Manufacturer: Genentech Inc.
Commonly Used With: Alimta + Cisplatin, Gemcitabine
Avastin has not been FDA approved to treat mesothelioma, but has been approved for the treatment of colorectal and lung cancers. In clinical trials, however, Avastin in combination with other chemotherapy drugs has shown improvement in overall survival and quality of life among mesothelioma patients. In a clinical trial held from 2008 to 2014, 223 patients received a combination of Avastin, Alimta and Cisplatin. This “triplet” therapy showed promising results, with patients’ experiencing a median survival of 19 months versus 16 months with the combination of just Alimta and Cisplatin. The triplet therapy, however, did have more adverse toxic side effects on patients than treatment without Avastin, including hypertension and thrombotic events.
Generic Name: Paraplatin
Manufacturer: Bristol-Myers Squibb
Commonly Used With: Gemcitabine, Alimta
Carboplatin is a chemotherapy drug that has been on the market since the 1980s, and has been popular for treating a variety of cancers, including lung and ovarian cancer. Unlike its parent compound, Cisplatin, Carboplatin has generally caused less severe side effects in patients, causing some disagreement around cisplatin versus carboplatin. A clinical trial testing the combination of Gemcitabine and Carboplatin saw overall positive results among the 50 patients tested. On average, patients saw a 15 month survival and didn’t experience disease progression for about 9 months. Another more recent clinical trial testing Carboplatin with Alimta in the treatment of malignant pleural mesothelioma found a median survival of 12 months in 102 patients, with 6.5 months before disease progression. These patients also experienced a better quality of life, as this combination was lower toxicity.
Generic Name: Platinol
Manufacturer: Bristol-Myers Squibb
Commonly Used With: Alimta, Gemcitabine
Cisplatin has been on the market since 1978, and has been used to treat many types of cancers such as ovarian, testicular, lung, and stomach cancers. Though not specifically FDA approved for the treatment of mesothelioma, it is often recommended by mesothelioma doctors when curative surgery is not an option, usually in the combination with Alimta or other chemotherapy drugs. Cisplatin with Alimta as a first-line chemotherapy treatment has been the standard of care for many years. Because of its development decades ago, however, Cisplatin is known for having potentially more severe side effects than other similar drugs.
Generic Name: Cytoxan, Cytophosphane, Neosar
Manufacturer: West Ward Pharmaceuticals
Commonly Used With: Pentostatin, Doxorubicin
Cyclophosphamide is mainly only being used in randomized phase clinical trials to see if it’s a viable combination chemotherapy for mesothelioma. In an ongoing clinical trial, Cyclophosphamide is being used in combination with Pentostatin, another chemotherapy drug that has been used to treat mainly hairy cell leukemia, and SS1P, an immunotherapy drug. This phase II trial is studying if the two chemotherapy drugs will make the SS1P more effective, and is suspected to conclude later this year. Other published clinical trials with Cyclophosphamide have tested its effectiveness with doxorubicin, which have seen mixed results so far. For instance, one 2010 study investigating these two drugs in combination with platinum-based chemotherapy found overall poor tumor response. The median for progression-free survival was a mere 1.5 months, which is much lower than the median when using the standard of care. Researchers hope with further study they will find the right combination for Cyclophosphamide to be most effective.
Generic Name: Adriamycin, Doxil
Manufacturer: Janssen Products
Commonly Used With: Cisplatin, Paclitaxel
Doxorubicin has shown many potential benefits for overall survival and tumor reduction for mesothelioma patients. It has been widely studied for mesothelioma, though is currently only FDA approved for the treatment of breast, lung and liver cancers, as well as leukemia. In a phase II clinical trial testing Doxorubicin with Cisplatin, researchers found a median overall survival of 19.6 months and nearly 5 months before the disease showed progression in patients with stage 3 or stage 4 mesothelioma. Another clinical trial suggested Doxorubicin could be a means of long-term survival in patients after examining the case of 67-year-old patient who worked in the asbestos industry and developed mesothelioma. Doxorubicin combined with Paclitaxel and Etoposide resulted in a 9 year survival for the patient, at the time the study was released.
Generic Name: Gemzar
Manufacturer: Eli Lilly and Company
Commonly Used With: Cisplatin, Carboplatin, Alimta
Gemcitabine is a newer chemotherapy drug, which has been approved to treat several types of cancers including non-small cell lung cancer, pancreatic cancer and breast cancer. It has often been used in combination with Cisplatin or Carboplatin as a first-line or second-line of treatment. Some studies have shown this treatment to have little positive impact on overall survival, though researchers concluded it is still a viable option because it provided a high stability rate (46% of 60 patients in the trial saw stable disease). Another study compared the standard of care (alimta and cisplatin) against Cisplatin or Carboplatin with Gemcitabine, and found the median survival was 11 months for either treatment in stage 4 mesothelioma patients.
Generic Name: Vinorelbine tartrate
Manufacturer: Pierre Fabre Pharmaceuticals
Commonly Used With: Cisplatin
Navelbine is another relatively new chemotherapy drug and has been commonly used in treating breast cancer, ovarian cancer and Hodgkin’s lymphoma. For mesothelioma patients, Navelbine has shown promise as both a first-line and second-line treatment, as well as among relapsed patients. One study Navelbine provide a nearly 10 month overall survival for malignant mesothelioma patients who had relapsed. A study of Navelbine and Cisplatin as a first-line treatment also saw promising results, as patients with inoperable mesothelioma saw a median survival of nearly 17 months.
Generic Name: Ranpirnase
Manufacturer: Alfacell Corporation
Commonly Used With: Doxorubicin
Onconase is a new experimental chemotherapy drug that has shown potential for a number of cancers including mesothelioma. It’s currently in an ongoing clinical trial studying its impact in combination with Doxorubicin. The most recent available results showed the combination extended median survival to 12 months compared to 10 months with just doxorubicin, with 47% patients still having survived at the year mark. Other studies have suggested that Onconase could be a valuable addition to treatment with other chemotherapy drugs, as it has been shown to help stabilize cancer cells and prevent tumor growth.
Generic Name: Taxol, Onxal
Manufacturer: Bristol-Myers Squibb
Commonly Used With: Cisplatin, Carboplatin
Paclitaxel has shown success in treating a number of cancers, such as breast cancer, ovarian cancer and lung cancer. Unfortunately, it has seen rather mixed results with its impact on mesothelioma. A phase II study found the chemotherapy drug found an average median survival of just about 9 months with a 30% one-year survival rate, which wasn’t nearly as successful as the other chemotherapy drugs commonly used in treatment. More current studies are evaluating Paclitaxel’s effectiveness in combination with Cisplatin and Carboplatin, which will hopefully show a more promising outcome.
Side Effects of Chemotherapy Drugs
Different chemotherapy drugs can have a variety of side effects, some more severe than others. Through clinical trials, researchers have also witnessed a range of side effects from different combinations or singular drugs, from nausea and hair loss to elevated blood pressure and hemorrhaging.
Side effects can also vary depending on how the drugs are applied, like systemic chemotherapy or more targeted intraperitoneal chemotherapy, and the dosage given (a higher mg/m will be more toxic with more adverse events possible). Side effects may occur at any time during or after the typical 21-day cycle of chemotherapy treatment.
Your doctor will be able to explain any expected side effects and will monitor your reactions to your treatment throughout. Between visits to your cancer center, you should keep track of any symptoms you’re experiencing, which will help your doctor recommend ways to better manage chemotherapy side effects, whether it’s tweaks to the treatment plan or lifestyle changes.
Most Common Side Effects
- Nausea and vomiting
- Loss of appetite
- Hair thinning or loss
- Increased risk of infection
- Decreased white blood cell and red blood cell counts
- Mouth sores, pain and dry mouth
- Skin rash
In addition to common side effects, mesothelioma patients may also be at risk of facing other potential issues because of the “off-label” use of the majority of these drugs. Off-label drug use references an FDA approved drug that is applied for a cancer or condition that the drug has not been specifically approved to treat.
That’s why most of the chemotherapy drugs listed above are only available in clinical trials, which not only test their efficacy but also their side effects and if it is safe for treating mesothelioma. While pemetrexed is the only FDA-approved chemotherapy drug for mesothelioma, the National Cancer Institute also references the combination of gemcitabine and cisplatin as an approved treatment.
Paying for Chemotherapy
Cancer treatment is expensive, with costs rising higher each year. Mesothelioma chemotherapy is estimated to cost as much as $50,000 per course of treatment. Considering patients often go through multiple courses, these expenses can add up quickly.
Having a good insurance plan can help cover some of the costs of chemotherapy and mesothelioma treatment, and it’s just as important to understand what your plan will and will not cover. For instance, if you have a plan based on copayments, you may have a fixed payment each time you receive chemotherapy. If you have a deductible plan, you will pay out of pocket for treatment until you have reached the set deductible amount. Fortunately, plans generally have a cap that sets the maximum amount of out-of-pocket payments for your medical care.
Patients may also ask their doctors and medical team if there’s an alternative for an expensive treatment. With chemotherapy drugs, there may be a generic brand that has the same effects as a name brand drug at less cost.
Even limited out-of-pocket costs can still be too expensive for many households on top of regular household bills and secondary costs that come with cancer treatment. If you’re looking for other ways to help offset the cost of treatment, you may find more resources on our financial planning page, which provides some assistance options for treatment, lodging, and travel expenses.