Goals of Chemotherapy
There may be several reasons for chemotherapy, according to cancer stage, time of diagnosis, the health condition and age of the patient. Since chemotherapy is not considered as "curative" for mesothelioma, the goals are:
• Stop the cancer by controlling its spread and slowing its growth.
• Shrink tumors before surgery or other treatments. This is known as neoadjuvant chemotherapy
• Obliterate microscopic diseases that remain after surgery. This is adjuvant chemotherapy.
• Relieve pain and other symptoms. This is known as palliative chemotherapy and is administered when there is no expectation of any radical reduction of the tumor.
Most commonly, chemotherapy is an option for non-surgical candidates, but many cancer centers already conduct trials that use neoadjuvant approach. Alimta (pemetrexed) is the first chemotherapy drug approved by the FDA (Food and Drug Administration) specifically for mesothelioma; it is for use with Cisplatin in treating patients that have malignant pleural mesothelioma who are either unresectable or not recommended for curative surgery. Alimta/Cisplatin chemotherapy is the most effective first line of treatment for patients who are non-surgical candidates. Alimta is a multi-targeted anti-folate medicine that blocks the enzymes essential for DNA duplication and cell distribution. During a trial process, the Alimta/Cisplatin combination increased average survival of pleural mesothelioma patients by an approximated period of three months as opposed to treatment with Cisplatin alone. Check out Eli Lilly's information about treatment with Alimta.
You may start with Vitamin B12 supplement injections on the week before the treatment and this needs to be repeated every 9 weeks. You also need to take folic acid orally on a daily basis, 21 days subsequent to the last cycle of Alimta. In addition, you will have to take an oral steroid to reduce the danger of possible side effects such as skin rashes. Alimta/Cisplatin regimen is administered on an outpatient basis, involving a 10-minute intravenous transfusion of Alimta and a 2-hour Cisplatin infusion. The number of times you need to receive the treatment will depend on your response to the drug and the side effects you may experience.
As always emphasized, an open communication between the patient and his doctor is important for any medical treatment. This communication should involve discussions on the administration of the drugs, its effectiveness and possible side effects. Your doctor will advise you on the appropriate dosages of each of the mentioned medication; take note that you should inform him of any medicines that you are currently taking, even non-prescription drugs, so both of you will be prepared for any adverse interaction. For some mesothelioma patients, there may be some side effects of Alimta/Cisplatin, ranging from mild to moderate like nausea, vomiting or fatigue which are normally managed by your physician. But for other patients, side effects can be unbearable and dosages of the drugs may be reduced or the entire program be stopped. You need to mention all potential side effects to your physician.
Administration of Chemotherapy
The most popular way of chemotherapy administration is through a vein or intravenously which allows a rapid entry of drugs to the blood stream. Medications may also be transmitted via ports and/or catheters.
Catheters are flexible tubes which are soft and thin, inserted into a large vein in the patient's body and remain in place as long as necessary. Sometimes they may be attached to a small round plastic, a port or metal disc which is placed under the skin on the patient's chest.
For intraperitoneal chemotherapy, the catheter is introduced through the abdominal wall and the chemotherapy drugs are then infused to the abdominal cavity directly. Ports may also be inserted and the catheter channeled between the muscle and the skin into the peritoneum.
Here are examples of FAQs of undergoing chemotherapy.
Side Effects of Chemotherapy
Unlike normal cells, cancer cells grow and spread more rapidly. However, some normal cells multiply fast too, especially those located in the reproductive system, digestive tract and hair follicles. What actually causes side effects is the damage that occurs to normal cells. The type and severity of the side effects will depend on the type and dosage of chemo treatment you are receiving and your body's reactions. There is a form that you need to sign before the chemotherapy treatment. It is important that you have discussed relevant issues with your physician before affixing your signature; including details about the certain drug or drug combinations to be used, risks involved, potential side effects (peripheral neuropathy, nausea and vomiting), number and frequency of sessions and whether they will be administered on in-patient or outpatient basis.
Click this link if you want to learn more about chemotherapy treatment for mesothelioma and the issues you need to raise to your doctor.
Schedules of Chemotherapy Treatments
Chemotherapy treatment is done in cycles, with a "cycle" defined as a period of treatment and a period of rest. Each cycle lets the administered drugs to fight against the cancer cells and allows time for the normal cells to recover. The standard chemotherapy for mesothelioma patients is a combination of Alimta and Cisplatin which are administered intravenously. It is a ten-minute Alimta infusion plus a two-hour Cisplatin administration, given every 21 days.
Your doctor will advise you on the number of chemotherapy sessions that you will need, depending on essential factors, such as the cancer stage, type of drugs you will receive and the anticipated toxicities, as well as the length of the recovery period. The physician also considers if the goal of the treatment is controlling cancer growth or just easing the symptoms of the disease. The drugs being used, the length of time to administer them, the frequency of administration and the number of cycles needed have all been thoroughly analyzed in clinical trials.
There may be variations in the number of treatment cycles and length of time; but in general, a response can be evaluated after three to four cycles. Two or three cycles are the minimum requirement to assess the effectiveness of the treatment. After determining the patient's response, whether the chemotherapy will continue is decided based on the following:
• There is a reduction of the tumor; or there is a certain level of stability in the disease – chemotherapy may continue as long as the patient can tolerate it and there is no disease progression.
• There is a continuous progression in the disease – chemotherapy will be discontinued; alternative options will be considered.
It is important to set a chemotherapy schedule in order to make the treatment timely, effective and trouble-free. The drugs work to kill cancer cells but they may also cause side effects to healthy cells, among them is a chemotherapy-induced lowering of the white blood cell count (neutropenia) that weakens the immune system, leaving the patient more prone to infection. This may cause some delay in the treatment schedule or may affect the dosage of the drugs to be administered. For information about your blood counts, click this link.
Note to Patients Undergoing Chemotherapy Treatments:
Chemotherapy treatment is a collaborative effort between the patient and the doctor. The interaction will greatly help to make the patient feel better and to increase the chances of survival.
1. Inform your doctor of any side effects resulting from the therapy, which may include one or many of the following:
o Fever, 101 degrees or higher
o Vomiting and nausea
o Constipation or diarrhea
o Exhaustion
o Numbness or tingling in the toes or fingers
o Buzzing sound in the ears
o Rashes and bruises
o Sores in the throat or mouth
2. Take only doctor-recommended medications as taking any other drugs may alter the effects of chemotherapy and may cause undesirable interactions. Take only aspirin if your doctor approves it.
3. Be extra cautious of your health. Maintain your ideal weight, eat healthy foods and drink plenty of liquids. If necessary, ask your doctor to recommend a nutritionist to monitor your intake needs. As already mentioned, chemotherapy weakens the immune system, so avoid association with persons who have flu or colds. Do not miss any appointment for blood work as this will help your physician monitor your condition.
4. Try to be open about your feelings. Emotions of sadness, anger and fear are common for patients on chemo but try to master them so they won't be detrimental to your well-being. Allow yourself to be surrounded by supportive family, friends, your physician, a counselor or if possible, a support group.
RADIATION THERAPY
Also called radiotherapy, radiation therapy cures cancer by the use of penetrating high-energy beams or streams of particles known as radiation. In mesothelioma treatments, radiation is used aggressively with surgery, or palliatively for symptom-control.
In aggressive approach, radiation attacks residual or microscopic disease which remained in the chest cavity following extrapleural pneumonectomy. One example is IMRT (Intensity Modulated Radiation Therapy) which utilizes X-rays of various intensities in addition to computer-generated images. It delivers radiation directly to cancer cells and at the same time, reduces the amount of radiation to healthy tissues. Read more about IMRT (Intensity Modulated Radiation Therapy).
Palliatively, radiation helps control the spread of the tumor (metastases) along the tracks left by invasive process like needle biopsy, thoracoscopy and chest tube drainage. It also controls symptoms of the disease, such as pains and shortness of breath.
Latest News