TREATMENT: MORE ABOUT CHEMOTHERAPY

Types of Chemotherapy Agents Commonly Used to Treat Mesothelioma

Anthracyclines

Considered "standard" treatment for mesothelioma for decades, the anthracycline class of drugs has become somewhat less popular recently. Hair loss and risk of cardiac damage has been reduced with the use of cardiac protectants and liposomal formulations. Examples of the anthracyclines are doxorubicin, epirubicin, liposomal doxorubicin and daunorubicin and mitoxantrone.

Platinum Analogs

These drugs have shown consistent but modest benefit against mesothelioma, and are often given in combination with other drugs. Generally administered by vein every three to four weeks, these drugs can cause chronic nerve and kidney damage. Examples of platinum drugs are cisplatin, carboplatin, and oxaliplatin.

Antifolates

These drugs are among the most active against mesothelioma and have few long-term side effects. Examples of the antifolates include methotrexate, pemetrexed and raltitrexed. The University of Chicago investigator Nicholas J. Vogelzang MD led an international 472 patient trial that compared a standard chemotherapy agent, cisplatin, to cisplatin plus a new agent, pemetrexed (Alimta®). Patients treated with cisplatin plus pemetrexed lived longer, had more tumor shrinkage, and felt better than patients who received cisplatin alone. Learn more about Dr Vogelzang.

Gemcitabine

Gemcitabine is a commonly used, commercially available drug that is modestly effective against mesothelioma when given by itself, but has shown significant response rates when given in combination with other agents, such as cisplatin. Australian investigators demonstrated a 48% response rate and improved quality of life when gemcitabine was given with cisplatin. We have incorporated this combination regimen with novel targeted agents in some of our trials.

Alkaloids derived from plants

In spite of having four groups of drugs in this class (vincas, etoposide, taxanes, and camptothecins), most are surprisingly ineffective against mesothelioma. One exception is vinorelbine (Navelbine®), which can produce regressions in about 20% of patients, improving symptoms and quality of life.

Response Rates

The response rates of many of these drugs when used alone are listed below. This information was gathered from clinical trials conducted over the past 20 years from many different centers using differing criteria for response. Thus, these results may not reflect current results.