Receiving a diagnosis of mesothelioma is a profound and often overwhelming experience. This rare and aggressive cancer, most commonly caused by past exposure to asbestos, affects the thin layer of tissue covering the internal organs, primarily the lungs (pleura) or abdomen (peritoneum). Symptoms like shortness of breath, persistent chest pain, and severe fatigue can significantly impact daily activities and overall comfort. While the diagnosis carries heavy emotional weight, advancements in medical science have expanded the options available to manage the disease.

Treatment is essential to control the growth of the cancer, relieve debilitating symptoms, and extend survival. Because mesothelioma is often diagnosed at a later stage, the goal of care frequently blends active treatment with palliative measures to maximize quality of life. Treatment plans are highly personalized, depending on the location of the tumor, the stage of the disease, and whether the cancer can be removed surgically (American Cancer Society, 2023).

Overview of treatment options for Mesothelioma

The management of mesothelioma typically involves a multimodal approach. While surgery may be an option for early-stage disease to remove visible tumors, medication is the backbone of treatment for the vast majority of patients.

Pharmacological therapy focuses on systemic treatments that circulate throughout the body to reach cancer cells wherever they are located. Historically, chemotherapy was the only option. However, recent years have seen a major shift toward immunotherapy, which harnesses the body’s own immune system. Treatment is often categorized as either first-line (the initial treatment given) or second-line (treatment used if the first stops working). Palliative medications are also used concurrently to manage pain and improve breathing.

Medications used for Mesothelioma

For decades, the standard first-line treatment has been combination chemotherapy. This typically involves an antifolate drug, such as pemetrexed, paired with a platinum-based drug, usually cisplatin or carboplatin. Clinical experience suggests that using these two drugs together is more effective at shrinking tumors than using either alone. In some cases, a third drug called bevacizumab is added to this regimen to further inhibit tumor growth.

Recently, the FDA approved a dual immunotherapy regimen as a first-line treatment for patients with unresectable pleural mesothelioma. This combination includes nivolumab and ipilimumab. These medications are often used for patients who cannot undergo surgery or for whom chemotherapy is not the best option.

For peritoneal mesothelioma, chemotherapy is sometimes delivered directly into the abdomen, often heated, during surgery (HIPEC), though systemic chemotherapy remains a standard option as well. If the cancer progresses despite these treatments, doctors may try different chemotherapy agents, such as gemcitabine or vinorelbine, as second-line therapies (National Cancer Institute, 2023).

How these medications work

Chemotherapy drugs work by disrupting the life cycle of rapidly dividing cells. Platinum-based drugs damage the DNA inside the cancer cells, preventing them from repairing themselves. Antifolates like pemetrexed block specific enzymes the cells need to replicate. Together, they cause the cancer cells to die or stop dividing.

Immunotherapy works by a completely different mechanism known as “checkpoint inhibition.” Cancer cells often evade the immune system by sending signals that tell immune cells to leave them alone effectively putting the “brakes” on the immune response. Drugs like nivolumab and ipilimumab block these signals, releasing the brakes and allowing the patient’s own T-cells to identify, attack, and destroy the mesothelioma cells. Bevacizumab, often added to chemo, works by blocking the signals that tumors use to grow new blood vessels, essentially starving the tumor of its nutrient supply (Mayo Clinic, 2022).

Side effects and safety considerations

Chemotherapy targets fast-growing cells, including healthy ones, causing common side effects like fatigue, nausea, hair loss, infection risk (due to low blood counts), and sometimes neuropathy from platinum drugs.

Immunotherapy’s unique side effects stem from an overactive immune system attacking healthy organs, causing inflammation (pneumonitis, colitis, liver/gland issues). These immune-related adverse events can happen anytime. Regular blood tests monitor liver/kidney function. Urgent medical care is needed for sudden breathing difficulty, severe diarrhea, or rashes.

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

1. American Cancer Society. https://www.cancer.org
2. Mayo Clinic. https://www.mayoclinic.org
3. National Cancer Institute. https://www.cancer.gov
4. Food and Drug Administration. https://www.fda.gov