After someone comes to terms with a mesothelioma diagnosis, one of the first questions that the individual asks is what treatment options are standard for mesothelioma. Chemotherapy has been utilized over the years to reduce the size of cancerous tumors in a person’s body. The difficulty with older chemotherapy medications is that they did not work nearly as well as the medication that people use today. Medical providers have discovered that it is often a good idea to mix surgical options with chemotherapy drugs which now involve newer medications by people who are healthy enough to tolerate the medication.
These newer medications have been determined to work better than older medications. It has also been discovered that the combination of newer medications with surgery can let people live longer. Alimta, as well as cisplatin, are the only types of first-line treatments approved in this country for treating malignant mesothelioma. First-line means the first treatment that a person uses to treat cancer. First-line treatment for many people involves the combination of the two chemotherapy medications, pemetrexed, and cisplatin. Cisplatin is a type of alkylating agent or medication that works by attaching to an alkyl agent found in the cell’s DNA. During this binding process, cancer cells are believed to be destroyed.
The Role of Cisplatin
Cisplatin is administered through IV and does not come in an oral form. Because cisplatin is an irritant, it causes inflammation of a person’s veins. Due to the side effects of the illness, it is a good idea to let your medical team know if you encounter any discomfort at the site of your IV either during or after an infusion. The dosage that you receive will be influenced by various factors including your age, health status, and kidney function.
Cisplatin is received between one to two hours every three weeks. The drug impacts healthy cells similar to all other chemotherapy medications. This means that side effects from cisplatin are possible. Some of the most common side effects associated with cisplatin include fatigue, hair loss, and nausea. The drug can also harm a person’s kidneys. As a result, your doctor will likely check your baseline kidney functions before you receive the medication to decide whether your kidneys are adequately functioning enough to process the medication. If you are receiving treatment involving cisplatin, some substantial steps exist that you can follow to lower the possibility that your kidneys end up damaged, including increasing the amount of fluids that you drink. This additional fluid helps patients quickly remove the medication from their body by increasing the kidney’s function and protecting the kidneys. Due to the intravenous fluid used before and after cisplatin, patients often discover that it takes five hours to receive cisplatin. Cisplatin is sometimes jokingly referred to as “cis-flatten” due to the medication’s serious side effect. The drug can alter the taste of some foods and cause people to experience the taste of metal in the patient’s mouth. Neuropathy is a common cisplatin side effect and impacts a person’s nervous system as well as causes various sensations including numbness, burning, tingling, or pain in a person’s hands or feet. Fortunately, some medications prove helpful in lessening pain associated with neuropathy if it ends up developing. Sometimes, cisplatin can also impact a person’s hearing and inner ear. You should promptly let your medical team know if you experience any changes to your hearing including ringing. Cisplatin should be provided once during a 21-day cycle or every three weeks in addition to pemetrexed. Your medical team will likely visit with you between treatments. During this time, your medical team will evaluate your blood values including your CBC, which is a basic test of blood that determines the concentration of red blood cells, white blood cells, and platelets. Your medical team might also create a chemistry panel that examines your liver and kidney function as well as the presence of electrolytes, which are minerals that help fluid in the body balance and are important to helping the heart, muscles, and other organs work properly.
Alimta and Its Use in Treatment
Alimta (or as it is also known as pemetrexed) is a new type of medication used during chemotherapy. After many clinical trials, the medication was approved by the Food and Drug Administration in 2004. Sometimes, pemetrexed is given alone, but other times it is given in addition to cisplatin. The medication interacts with enzymes, which are proteins that speed up the pace of chemical reactions. Alimta works by blocking folate or any cell that uses B-vitamins like folate to create new genetic material. This is because Alimta blocks folate pathways located in cancer cells and consequently disrupts the ability of a cell to grow and replicate. To reduce the possibility of experiencing side effects while taking pemetrexed, patients should take folic acid and vitamin B12 both before as well as during, and following treatment. Your medical team will prescribe folic acid anywhere from 5 to 7 days before a patient begins pemetrexed. If you already take a multivitamin, the pill likely contains the appropriate 400 to 800 mcg of folic acid which is the appropriate dosage. Any additional folic acid that you take can end up altering how effective pemetrexed is. You should continue taking folic acid each day until 21 days following your final pemetrexed cycle. You will also require an injection of B-12 within the week that you begin taking pemetrexed. B-12 is given once every 9 weeks while a person is on chemotherapy.
Some of the most common effects associated with pemetrexed include reduced blood counts, nausea, fatigue, and vomiting. Skin irritation is also a common side effect of pemetrexed which is why it is important to let your medical team know if you become aware of rashes you might experience while taking pemetrexed. Your medical team might prescribe you a steroid tablet that you will take twice on the day before as well as the days of and after chemotherapy treatment to reduce your chances of experiencing skin irritation. Pemetrexed is also known to decrease a person’s appetite and cause diarrhea. If diarrhea or vomiting is too severe, it can end up causing dehydration which involves losing more fluid than your body can take in which makes your body become so depleted of fluid that it does not have enough water to function normally. Mouth sores which are also referred to as stomatitis can also happen and you should promptly let your medical team know if they can up occurring so you can receive immediate treatment.
Pemetrexed is given intravenously once every 21 days or 3 weeks. Infusion of pemetrexed runs around 10 minutes. The dosage of the drug depends on various factors including your general health and age. Your medical team will visit with you between rounds of treatment while you are receiving pemetrexed to evaluate how you are doing and to take blood samples to assess your CBC to ensure that the medication has not led to your blood cells dropping too quickly.
Gemcitabine (Gemzar) Treatment
Another type of chemotherapy medication used to treat mesothelioma, antimetabolites found in Gemcitabine interrupt DNA production, which stops cell growth as well as cell division and leads to the slowing or even stoppage of a person’s cancer. Because cancer cells tend to divide faster and with less of an ability to correct errors than healthy cells, cancer cells have increased sensitivity to damage of this kind. Gemcitabine terminates cancer cells that proceed through DNA synthesis. The medication also stops ribonucleotide reductase, which is an enzyme critical to DNA synthesis. Because cells are unable to copy their DNA, the cells are left unable to divide and as a result, die.
Gemcitabine is given through an IV infusion over 30 minutes. The exact dosage, as well as the schedule for the medication’s dosage, depends on a person’s size as well as cancer. The medication is sometimes given in addition to other types of treatments including radiation.
When given at the same time as radiation, there can be an increased number of side effects that a person experiences. A period of at least one week should pass between the date the treatment begins and the completion of radiation therapy and a full dosage of the medication. A patient should also make sure that the individual’s healthcare providers are aware of the patient’s treatment history with gemcitabine and/or radiation. Patients can experience gemcitabine toxicity if the medication is given for over 60 minutes or if the medication is given more than once a week.
Some of the side effects of the medication include flu-like symptoms, reduced blood counts, and lowered blood pressure. Patients are also closely monitored for toxicity. Fortunately, you can do several things to manage the side effects brought on by the medication. You should speak with your medical team to learn what these recommendations are. Your medical team can help you decide what works best for you. Some additional side effects caused by the medication include nausea, toxicity of the liver, lowered red blood cell counts, and reduced white blood cell counts.
What to Do After Treatment
After treatment with both cisplatin and pemetrexed, you will have a temporary period until your tumor starts to become active again. During this time, you should consider second-line therapy. Many medications as well as medication combinations have shown some helpfulness in treating mesothelioma but have not been studied in big enough numbers to receive Food and Drug Administration designations as second-line therapy that has been approved, particularly for mesothelioma treatment.
Insurance carriers often deny these therapies, but many times will allow treatment after a denial followed by an appeal process. Each insurance plan is different, but obtaining approval for the recommended use of a drug that is approved for treating cancers other than mesothelioma is often a lengthy process that takes several weeks and creates many difficult emotions for patients. Many times, this process resolves peacefully and permission is given for a person to receive the medication. Sometimes, however, a patient and the patient’s medical team have to review other alternative agents or techniques for combatting the illness. Some of these techniques include receiving legal assistance, paying out of pocket for medication even though this is often extremely pricey, or trying to obtain support from a foundation or drug company that produces the drug to pay a lower amount for the treatment.
If you or a loved one has finished your initial treatment and are in the phase of watching and waiting, you have time to explore potential second-line therapy or next treatment options. Various trials exist for what second-line therapy works best, but some factors can leave a person not eligible to participate in these trials. Second-line therapy is not part of a trial but can be used at any time. Clinical studies often occur before second-line therapy but require that you have failed one regimen. Sometimes, these trials disqualify people if they have received additional treatment. As a result, it is important to obtain this right and leave as many techniques as open for the future as possible.
If your tumor has advanced and you must seek immediate treatment, you should appreciate that new treatment is not initiated until a person is at least 4 or more weeks out from having completed treatment. This period is critical because any toxicities must be completely resolved so no confusion exists concerning the side effects you ultimately develop as the result of the first drugs you took or the second-line ones.
You will also require a new exhaustive workshop about the nature and degree of your disease, which often includes both laboratories as well as radiological studies. If you are entered as a part of a protocol, you should appreciate that some people in this situation require additional protocol-specific tests. Scans are scheduled close to the time that you begin your new regimen so measurements can be received of your residual or new tumors for accurate comparisons.
If you enter into a clinical trial utilizing a new agent that is not yet approved to treat mesothelioma or any other type of cancer, you will receive the medication free of cost but will face costs associated with what is viewed as the standard of care. This might encompass laboratory studies or other evaluations that would routinely be given or performed even if you are not entered into a clinical study. These details should all be reviewed with your medical team at the time you consent to treatment. You have the right to understand your financial obligations and should both insist on and receive full disclosure of what to expect.
If you are experiencing financial difficulties, you should arrange an appointment with a social worker. Remember, social workers receive training to help discuss and address any issues that you encounter with insurance carriers. Social workers can also help you locate organizations that offer financial help and networks with pharmaceutical companies to help you receive free or reduced-price medication. This is an advantageous resource along with the case manager that you will be assigned by your insurance plan.
Radiation and Mesothelioma Treatment
The role of radiation in treating mesothelioma is still largely undefined. Radiation in mesothelioma treatment has been utilized to control the various symptoms associated with cancer including pain. It has not been discovered to be advantageous as an option for primary treatment. Therapy involving radiation is now utilized as part of a combination including surgery and/or chemotherapy to determine whether the treatment can eliminate the cancer cells in a person’s body following surgery and prevent the return of cancer, particularly when mesothelioma starts in a person’s chest.
Radiation is most often given in one of two ways to treat mesothelioma. One, radiation treatment might be given after surgery to eliminate any small areas of cancer in a person’s body that could not be seen and removed during surgery. This type of treatment is called adjuvant radiation therapy. Another type of radiation treatment focuses on reducing the symptoms associated with mesothelioma that most substantially disrupt a person’s life including pain, shortness of breath, bleeding, or difficulty swallowing. Radiation therapy for mesothelioma treatment relies on high energy particles to terminate cancer cells as well as prevent the cancer cells from further spreading. Radiation also helps to reduce pain by reducing the size of tumors. Your medical team will carefully review your situation to decide what type of treatment works best for you.
A great deal of research must still be performed in this area and clinical trials are currently in the process of being performed to determine answers to these questions to distinguish the best treatment strategy for people with mesothelioma during the original diagnosis of a mesothelioma patient in addition to times when recurrence happens. Cancer’s return after a tumor had disappeared at the site of the first or primary tumor or another spot in the patient’s body.
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