NCCN Guidelines for Patients
Malignant Pleural Mesothelioma
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Chemotherapy drugs stop the growth process of cells
in an active growth phase. Cancer cells grow fast, so
chemotherapy works well to stop new cancer cells from
being made. However, it also kills normal cells and can
cause side effects. Ask your doctor for a list of all the side
effects caused by the chemotherapy drugs you will have.
All of the chemotherapy drugs listed in the table below
are liquids that are slowly injected into your vein.
Cisplatin with pemetrexed is preferred for first-line
treatment. But, gemcitabine with cisplatin is a good
option if you cannot take pemetrexed. And pemetrexed
with carboplatin is a good option if you have poor overall
health, difficulty doing daily activities, or other serious
Chemotherapy is given in cycles of treatment days
followed by days of rest. Cycles give the body a chance
to recover before the next treatment. The length of 1 cycle
of pemetrexed and cisplatin is 21 days. Pemetrexed
and cisplatin are given on Day 1 of the cycle. Other
treatments that also follow this cycle include pemetrexed
with carboplatin and pemetrexed alone.
The length of 1 cycle of gemcitabine and cisplatin is
to 28 days. For each cycle, gemcitabine is given on
Days 1, 8, and 15, and cisplatin is given only on Day 1.
Vinorelbine is given 1 time every 7 days.
If the cancer grows or spreads after first-line treatment,
then you may receive second-line treatment. However,
there is little research to provide guidelines for second-
line treatment. If given as first-line treatment, pemetrexed
should only be given as second-line treatment if a good,
lasting response was achieved with it the first time.
Part 5: Treating mesothelioma
Stage I – III sarcomatoid or Stage IV mesothelioma
First-line treatment Second-line treatment
Pemetrexed + cisplatin
Pemetrexed + carboplatin Vinorelbine
Gemcitabine + cisplatin