More than 100 chemotherapy drugs are used to treat cancers such as mesothelioma. They may be used alone or in combination with other treatments such as surgery or radiation. In her book The Chemotherapy Survival Guide, oncology certified nurse Judith McKay says, “chemotherapy drugs work by interfering with the sequence of activities that a cell must go through to divide into two identical daughter cells.” If the cell can’t divide, she says, “then it will live out its life span and die. Drugs that act this way are called cell-cycle specific or antimetabolites. They prevent cancer cells from reproducing at a particular phase in the cell’s life span.” Just a few common types of cell-cycle specific chemotherapy drugs are Pemetrexed (Alimta), Gemcitabine (Gemzar), and Hydroxyurea.
Other types of chemotherapy drugs called cell-cycle nonspecific affect cancer cells in every phase of life. They kill cancer cells without waiting for them to divide at any time during the cells life span. Also called alkylating agents, these types of drugs affect cancer cells far more than healthy cells because cancer cells are often more fragile or immature than normal cells. Some of the most common types of cell-cycle nonspecific chemotherapy drugs are Carboplatin, Cisplatin, and Temozolomide.
All chemotherapy drugs have risks and side effects as chemotherapy is a “systemic” treatment that works throughout the body to destroy rapidly growing cancer cells. As a result, chemotherapy may also effect healthy cells that divide quickly. This can cause unpleasant side effects such as fatigue, hair loss, mouth sores, decreased blood cell counts, nausea, vomiting, and pain. However, because chemotherapy is very effective against rapidly growing cancer cells, the benefits often outweigh the risks.
Because chemotherapy can also affect healthy cells, researchers are hard at work developing drugs that target cancer cells specifically, while leaving healthy cells alone. A number of targeted therapies have been approved by the U.S. Food and Drug Administration (FDA). A few standouts include Nivolumab (Opdivo), Pembrolizumab (Keytruda), and Sunitinib Malate (Sutent).
Nivolumab (Opdivo) and Pembrolizumab (Keytruda) have been approved for the treatment of non-small cell lung cancer, which gives new hope to patients with malignant pleural mesothelioma. Sutent is currently approved for the treatment of pancreatic cancer, gastrointestinal stromal tumor, and kidney cancer. Researchers are now studying the drug for many other types of rare cancers, including malignant pleural mesothelioma.
Says the American Cancer Society, targeted therapies such as these can work to:
- Change proteins within the cancer cells so the cells die
- Carry toxins to the cancer cells to kill them, but not normal cells
- Block or turn off chemical signals that tell the cancer cell to grow and divide
- Trigger your immune system to kill the cancer cells
- Stop making new blood vessels to feed the cancer cells
“Some targeted drugs are more “targeted” than others, while some might target only a single change in cancer cells,” explains the Society. Some can affect several different changes while, “others boost the way your body fights the cancer cells. This can affect where these drugs work and what side effects they cause.”
Not every person will experience side effects, but the most common side effects are rashes or other skin changes such as photosensitivity, dry skin, and itching. Targeted therapies can cause changes in hair growth, skin and hair color, and changes around the eyes. It is important to note that side effects from targeted cancer therapy appear to be less severe than those experienced during chemotherapy treatments.
To summarize, targeted therapies differ from standard chemotherapy in several ways:
- Most standard chemotherapies act on all rapidly dividing normal and cancerous cells, whereas targeted therapies act on specific molecular targets that are associated with cancer
- Many standard chemotherapies were identified because they kill cells, whereas targeted therapies are deliberately chosen or designed to interact with their target
- Standard chemotherapy agents are cytotoxic (that is, they kill tumor cells), whereas targeted therapies are often cytostatic (that is, they block tumor cell proliferation)
The decision about whether targeted cancer therapy, chemotherapy, or a combination of the two is the best way to treat mesothelioma will depend on many factors that can only be assessed by a mesothelioma specialist. Your specialist will work with you to determine the course that will be the most effective in treating your specific type mesothelioma.
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