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Home > Traditional treatment > Chemotherapy Drugs for Mesothelioma Treatment


Chemotherapy Drugs for Mesothelioma Treatment



The usage of chemotherapy may be combined with surgery intervention in order to make the mesothelioma tumor enlarging slower. In cases when applying surgery is inappropriate due to high cancer advancing, chemotherapy also appears successful.

There are the following chemotherapy drugs:

  • Cytotoxic chemotherapies
    • Camptothecins
    • Doxorubicin
    • Edatrexate
    • Gemcitabine
    • Methotrexate
    • Pemetrexed (Alimta®)
    • Raltitrexed (Tomudex®)
    • Ranpirnase or P–30 Protein (Onconase®)
    • Vinorelbine
    • Platinum Compounds and Anti–Metabolites
  • Noncytotoxic drug therapies
    • Drugs which inhibit VEGF
    • Angiogenesis inhibitors, include
      • SU5416
      • bevacizumab
      • thalidomide
      • PTK 787

The usage of chemotherapy may be combined with surgery intervention in order to make the mesothelioma tumor enlarging slower. In cases when applying surgery is inappropriate due to high cancer advancing, chemotherapy also appears successful.

Cytotoxic chemotherapies

- The camptothecins like topotecan or irinotecan didn't cause significant reactions applied as single agents, whether their combination with some other drugs has shown good results.

- The gold standard was shown by doxorubicin that has produced 14% response rate. The same results were shown by its analog, epirubicin. The rate slightly over 10% was also shown by platinums.

- 25% response rate of edatrexate is compensated by its high toxicity. Possible toxicity treatment caused lowering of effectiveness for this drug.

- Current gold standard is the combination of gemcitabine and cisplatin. Its initial researches gave 48% of response. Though, this combination has showed further rates of 26%, 16%, and 9%.

- Methotrexate also gives appropriate response rates but it is impossible to be applied in case of a pleural effusion.

- The first drug tested as a special treatment for pleural mesothelioma is pemetrexed. It acts prolonging the survival time of the patient and increases his or her wellbeing. There are some new drugs, like raltitrexed and ranpirnase but they are still in the testing period. The treatment of pleural mesothelioma by a combination of pemetrexed (Alimta & reg), and cisplatin (standard platinum compound) was approved by the U.S. FDA (Food and Drug Administration) in February, 2004. Some doctors think of this new treatment as of a great success for mesothelioma patients.

The principle of pemetrexed acting is lowering the thymidine and purine synthesis which are obligatory for cells growth. Alimta® can't cure mesothelioma, but nevertheless it eases the pain and enlarges the survival period. It presents another hope for those whose pleural mesothelioma is too advanced for the surgery to be appropriate treatment.

Patients taking pemetrexed may suffer a number of side effects like nausea, vomiting, diarrhea, fatigue, mouth sores, and lowered blood counts, which can possibly be reduced by taking vitamin B12. In order to avoid rashes the doctor may offer a corticosteroid. This is a steroid taken from the cortex of the adrenal gland as well as substituted synthetically.

Platinum Compounds and Anti-Metabolites

Cisplatin, carboplatin, and oxaliplatin - the compounds containing platinum are poisonous for cancer cells. Lung cancer is treated both by cisplatin and carboplatin, whether for colorectal cancer it is better to use oxaliplatin. The results of taking these compounds are not sure to be reached, though it gives some improvement to mesothelioma patients.

Other combinations with platinum compounds are being developed. 26% of clinically trialed mesothelioma patients have results like pain relief, breathing improvement and weight gain after taking cisplatin in combination with gemcitabine, a chemotherapy drug. Gemcitabine acts in a different way, being an anti-metabolite. It prevents cancerous cells from producing DNA (repairing deoxyribonucleic acid) that is the genetic material for cells. Further researches will certainly provide mesothelioma patients with additional pluses of cisplatin/gemcitabine therapy.

- Raltitrexed prevents cancerous cells from producing DNA (deoxyribonucleic acid) and makes troubles for cells reproduction. A result of 20% response rate was reached during the usage of raltitrexed alone in one of the initial researches. A close response rate was reached by applying raltitrexed in combination with oxaliplatin, a platinum compound, during another research.

- The protein production may be paused and the cancer cells extending speed reduced acordingly with help of Onconase® - a ribonuclease isolated from the leopard frog eggs. One-year and two-year survival rates of 34.3% and 21.6 % accordingly were reached during a limited study of 105 people at which patients were treated by Onconase®. In comparison to this, the average rate of survivals without treatment is from 6 to 8 months. Clinical trials of more advanced level are now testing the effects of combination including Onconase® and doxorubicin (a drug used for chemotherapy in most cancer cases) for mesothelioma patients.

- A plant alkaloid, vinorelbine, halts the division of cancerous cells. Its common usage used to be for breast cancer as well as considerable cell lung cancer treatment. Its clinical usage for mesothelioma patients' trials has started recently. The drug showed appropriate low toxicity and slight sight effects along with considerable pain reduction and the improvement of life quality of certain patients. Vinorelbine is planned to be tested in combination with a number of chemotherapy drugs to find out effects of these combinations.

Noncytotoxic chemotherapies

These are the medicine like VEGF and angiogenesis inhibitors, such as SU5416, bevacizumab, thalidomide, and PTK 787.

VEGF, or vascular endothelial growth factor, is a factor of autocrine growth. VEGF is more frequent for mesothelioma patients than for the ones with any other form of solid cancer. In the meaning of mesothelioma, VEGF relates to microvessel density, which is relatively spoken when low survival rate of mesothelioma patients is implied. Such drugs as SU5416, bevacizumab, thalidomide, and PTK 787 are called angiogenesis inhibitors and have the ability to inhibit VEGF.

SU5416 showed acceptable results during the second phase of University of Chicago research which has declared 11% of partial responses and 11% of minor responses from patients. The combination of cytotoxic medicine and angiogenesis inhibitors tested on animal models gave a shocking effect of symbiosis. The University of Chicago keeps researching with the usage of bevacizumab, a stronger angiogenesis inhibitor, combined with gemcitabine and cisplatin, against gemcitabine and cisplatin alone. The second phase is also applied to thalidomide.

Another factor, which is overexpressed in mesothelioma, is EGFR (Epidermal growth factor receptor). 11 of 13 epithelioid tumors as well as one of seven sarcomatoid tumors and two of four biphasic tumors have shown overexpressed EGFR. ZD1839 (Iressa) is being studied as EGFR inhibitor by CALGB (The Cancer and Leukemia Group B).

Platelet-derived growth factor (PDGF) is one mor factor of the autocrine growth for mesothelioma, like VEGF. PTK 787, the drug able to inhibit VEGF, as well as PDGF is being researched by CALGB. A good result in leukemia was reched by Gleevec, STI-571 which is able to carry out c-kit inhibition. The University of Chicago is planning to get down to phase II research of Gleevec as far it is also capable to slower PDGF.

Side Effects of Chemotherapy for Mesothelioma Patients

In most cases taking chemotherapy medicines is supposed to be followed by tiredness as well as exhaustion in some cases. Further effect may be: hair loss, nausea and vomiting.

The type of drug, used during the therapy, its doses, along with the treatment length, determines possible side effects. Consultations with the doctor before the chemotherapy as well as after this procedure will let the patient know which side effects to expect and possible ways to ease these effects. Refer to Mesothelioma Treatment: Side Effects of Chemotherapy discussion to get further information.

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