Chemotherapy for Malignant Mesothelioma

Your doctor may prescribe chemotherapy drugs, which destroy cancer cells throughout the body, along with surgery and radiation therapy for more aggressive cancers.

Sometimes, doctors prescribe chemotherapy alone if a person can’t have surgery due to poor health, or if the cancer has spread throughout the body.

For people who have pleural or peritoneal mesothelioma, doctors usually give chemotherapy before surgery. The goal is to shrink the tumor as much as possible, then remove any remaining cancer.

For people who are diagnosed early and have minimal disease, doctors may give chemotherapy after surgery to help reduce the risk of a recurrence.

Standard chemotherapy for pleural mesothelioma involves a combination of two drugs, pemetrexed and cisplatin. They are usually given over the course of several hours through a vein with intravenous (IV) infusion, once every 21 days—a time period known as a cycle. Doctors may prescribe these drugs for two to four cycles.

If the tumor does not shrink after the first two cycles, your doctor may recommend that you have four cycles. If the cancer returns, your doctor may prescribe different chemotherapy drugs.

Sometimes, doctors deliver chemotherapy directly into the pleural cavity through a catheter, or narrow tube. This may be an effective approach in people with early cancer. It increases the concentration of the drug in the area where cancer is present while decreasing the risk of side effects, because exposure to the rest of the body is limited.

NYU Langone doctors may use cytoreduction surgery plus a special type of chemotherapy known as hyperthermic intraperitoneal chemotherapy to manage peritoneal mesothelioma.

Hyperthermic intraperitoneal chemotherapy uses a machine to deliver heated drugs directly into the abdomen in the operating room, immediately after mesothelioma tumors are surgically removed.

Treatment takes about an hour and a half. Heating the chemotherapy drugs makes them more effective at destroying any cancer cells that may be left behind after surgery.

Some chemotherapy drugs may cause mouth sores, nausea, vomiting, and diarrhea. NYU Langone’s Perlmutter Cancer Center is open seven days a week, so our oncologists, nurses, and pain management specialists can help manage any side effects. Our support services can also help you address any long-term side effects.

If the cancer doesn’t respond to traditional chemotherapy drugs, your doctor may recommend that you participate in a clinical trial, which tests promising new treatments.

Researchers are studying many new therapies. These include drugs that target specific proteins or molecules in mesothelioma tumors; drugs that interfere with a certain pathway—meaning a series of chemical reactions that keeps cancer cells alive; or drugs that target the immune system, called immunotherapy.

In addition, researchers at NYU Langone’s Perlmutter Cancer Center are studying investigational treatments known as gene therapy, which modify cancer cell genes, causing them to die or to be destroyed by the immune system.