CHEMOTHERAPY, ONE OF SOLUTION FOR MESOTHELIOMA
CHEMOTHERAPY
Chemotherapy is defined as the
treatment of cancer using chemical substances. When cancer occurs, abnormal
cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work
to destroy cancer cells by preventing them from multiplying.
Purposes of Chemotherapy
Chemotherapy may be used to achieve
different goals, depending on the stage of the cancer at the time of diagnosis
and the age and health of the patient. Since chemotherapy for mesothelioma is
not considered “curative”, the goal is:
- To control the cancer by stopping its spread or slowing its growth.
- To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
- To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
- To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.
The most common use for chemotherapy
in mesothelioma patients is as an option for those who are not surgical
candidates; however, cancer centers are conducting trials using the neoadjuvant approach (giving chemotherapy before
surgery). Alimta (pemetrexed) is a drug approved by the Food and Drug
Administration (FDA) for use with Cisplatin in the treatment of patients with
malignant pleural mesothelioma whose disease is either unresectable or who are
not candidates for curative surgery. Alimta is the first drug approval specific
to mesothelioma.
The Alimta/Cisplatin chemotherapy
regimen is the first Food and Drug Administration (FDA) approved treatment
specifically for malignant pleural mesothelioma. This is currently considered
the most effective first-line treatment for mesothelioma patients who are not
surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking
the enzymes necessary for DNA copying and cell division. During the clinical
trial process, Alimta/Cisplatin improved median survival for pleural
mesothelioma patients by approximately three months over treatment with
Cisplatin as a single agent.
As with any medical treatment, it is
important to discuss the use of Alimta with your doctor. This conversation
should include all pertinent information regarding effectiveness,
administration and possible side effects of the drug combination. It is also
important to begin vitamin supplementation of B12 by injection during the week
prior to treatment (to be repeated every 9 weeks), and folic acid by mouth
daily (to be continued until 21 days after the last cycle of Alimta).
Additionally, you will be given an oral steroid medication to minimize the risk
of skin rash or other possible side effects. Your doctor will have information
on the correct dosages of each medication. Be sure to tell your doctor of any
other medications you are taking (including non-prescription drugs) so he may
be aware of any adverse interactions.
Alimta/Cisplatin is administered to
patients on an outpatient basis every 21 days. This cycle of treatment consists
of a 10-minute IV infusion of Alimta followed by a 2-hour infusion of
Cisplatin. How many cycles of treatment you receive depends on your response to
the drug (regression of the tumor or halt to progression of the disease) and
the side effects you might experience.
Side effects of Alimta/Cisplatin are
mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and
fatigue, and can usually be managed by your doctor. For some patients, however,
side effects may be debilitating, and may require a decrease in dosage or
removal from the program. All potential side effects should be mentioned to
your doctor. Never assume any complaint is minor.
Administration of Chemotherapy
The most common way to administer
chemotherapy is intravenously, or through a vein. A thin needle is inserted
into a vein in the hand or in the lower arm. Intravenous administration of
drugs allows for rapid entry into the blood stream. Drugs may also be delivered
via catheters and/or ports.
- Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.
- The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.
Intraperitoneal chemotherapy may
also be delivered through a catheter or a port. The catheter is inserted
through the abdominal wall. Chemotherapy drugs can then be infused directly
into the abdominal cavity for treatment of peritoneal mesothelioma. Ports may also be
placed under the skin of the abdominal wall and the catheter tunneled between
the skin and muscle into the peritoneum.
Frequently asked questions about being a chemotherapy
patient.
Side Effects of Chemotherapy
Cancer cells grow and divide more
rapidly than normal cells, but some normal cells also multiply quickly,
particularly those in the digestive tract, reproduction system, and hair
follicles. It is the damage done to normal cells that causes side effects. The
type of side effects you might experience and how severe they are, depend on
the type of chemotherapy you are receiving, the dosage given and how your own
body reacts. Before beginning any chemotherapy treatment, you will be asked to
sign a consent form. Before signing the form, be sure your doctor informs you
of all the facts regarding the treatment he/she will be administering,
including information about the particular drug or combination of drugs to be
used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments
you will receive and how often, and whether it will be given during a hospital
stay or on an outpatient basis. More on vomiting and nausea from chemotherapy.
Chemotherapy Schedules
How often you will receive
chemotherapy will be determined by your doctor, taking into consideration
factors such as the stage of your cancer, the types of drugs you receive, the
anticipated toxicities of the drugs and the time necessary for your body to
recover from these toxicities. The doctor may also consider whether the goal of
the chemotherapy is to control the growth of the cancer, or to ease symptoms
associated with the disease.
In general, chemotherapy treatment
is administered in “cycles” — a “cycle” being defined as a period of treatment
followed by a period of rest. This cycle allows the cancer cells to be attacked
by the drugs, and then allows the body’s normal cells time to recover. The
combination of drugs used, the length of time to administer the drugs, how
often they should be repeated and the number of cycles recommended have been
analyzed throughly in clinical trials. For mesothelioma patients, the
“standard” treatment is a combination of Alimta and cisplatin, administered IV,
with a 10 minute infusion of Alimta followed by two hours of cisplatin, given
in 21 day cycles. Modifications to this schedule may be made according to what
your doctor feels is appropriate in your particular case.
The number of treatment cycles, or
the length of time between the beginning and end of chemotherapy may vary,
however in general, 3 to 4 cycles of treatment are given before response is
evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness.
After response to the treatment has been determined, the following criteria
will be used to decide whether chemotherapy should continue:
- If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
- If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.
The goal of setting a chemotherapy
schedule is to make treatment as effective, timely and trouble-free as
possible, but while the drugs are working to kill cancer cells, they may also
affect healthy cells causing side effects. One of the most common side effects,
and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which
means your immune system is weakened, therefore leaving you more prone to
infection. While this side effect is anticipated when someone is undergoing
chemotherapy, it can cause delays in your treatment schedule, or changes in the
dosage of the drugs you will receive.
Note to Patients:
Chemotherapy treatment should be a
cooperative effort between you and your doctor. The interaction that takes
place is important to your health. It will not only help you feel better, but
will also address any potential problems with miscommunication.
1. It is necessary for your doctor
to be aware of any side effects which may result from your chemotherapy
treatment.
These may include:
- Fever of, or greater than 101 degrees
- Nausea or vomiting
- Diarrhea or constipation
- Fatigue
- Tingling or numbness in the fingers or toes
- Ringing in the ears
- Bruises or rashes
- Sores in the mouth or throat
2. Taking other medication of any
kind can alter the effects of chemotherapy or cause undesirable interactions.
Be sure you report all
over-the-counter and prescribed medicines to your doctor. Don’t take aspirin
unless it has been approved by your doctor. Ask your pharmacist if aspirin is
contained in any drugs you plan to purchase.
3. Take extra care with your daily
health.
Try to maintain a stable weight by
eating a healthy diet and drinking plenty of fluids. If your stomach is upset,
ask your doctor for helpful hints or work with a nutritionist who can tailor a
program to your needs. Brush your teeth after every meal, or if you can’t
brush, rinse your mouth thoroughly with water.
Stay away from people who have colds
or the flu. Chemotherapy can compromise your immune system and lower your
resistance to germs. Make sure you keep appointments for blood work – these tests
help your doctor monitor your health.
4. Be open about your feelings
regarding your treatment.
It is normal to feel sad, angry or
afraid, however, letting these emotions get out of control can be detrimental
to your overall well-being. Seek out the help of family, friends, your doctor,
a counselor or a support group.
Categories:
Treatment
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