Alternative Chemotherapy Drugs

The standard of care for treating either pleural mesothelioma or peritoneal mesothelioma includes pemetrexed (brand name Alimta) and Cisplatin (brand name Platinol). However, there are other drugs that may be substituted for these.

Carboplatin (brand name Paraplatin)

This belongs to the class of drugs known as alkylating agents. These platinum-containing compounds damage the DNA of the cancer cells, causing what is called apoptosis, or programmed cell death. That means that when the body’s repair mechanisms find that a cell’s DNA is too severely damaged to be repaired, it will automatically kill that cell.

The toxic effect of these drugs affects both normal and cancerous cells. It kills more of the disease cells because rapidly dividing cancer cells are especially sensitive to drugs that harm DNA. However, the stem cells contained in bone marrow are also rapid dividers, which mean they can be destroyed, leading to the side effect of anemia.

There are common side effects to the use of carboplatin including:

  • Thinning hair
  • Loss of appetite
  • Stomach pain
  • Diarrhea
  • Constipation
  • Nausea (and possible vomiting)
  • Changes in taste

These side effects usually disappear after treatment has been completed.

There are more severe side effects; however, which require an immediate call to the doctor:

  • Allergic reactions, such as rash, hives, difficulty breathing, tightness in the chest, swelling of the face, lips, or tongue
  • Change in the amount of urine produced or dark colored urine
  • Hearing loss or ringing in the ears
  • Fever, chills, or sore throat
  • Redness, swelling, or pain at the injection site
  • Numbness or tingling in the hands or feet
  • Irritation or sores in the mouth
  • Persistent tiredness or weakness
  • Unusual bruising or bleeding
  • Vision loss or blurred vision
  • Yellowing of the skin or eyes

Carboplatin belongs to the same drug class as cisplatin and can be substituted for it in patients for whom cisplatin is not an option. This includes patients who are already experiencing hearing loss at the start of chemotherapy, or who are designated as having kidney insufficiency. This is determined by what’s known as creatinine clearance, or the volume of blood plasma that is cleared of the metabolic waste product known as creatinine. If the creatinine clearance is calculated as being less than 60 milliliters per minute using the Cockcroft and Gault equation, then the patient has kidney insufficiency.

Another criterion for using carboplatin instead of cisplatin is if the patient has congestive heart failure with the New York Heart Association functional classification of greater than II, which means they are experiencing fatigue, breathlessness, or other symptoms that interfere with daily activities.

Carboplatin-based therapy is considered an inferior adjuvant (secondary) therapy, so the decision to use it is made on a case by case basis. In younger patients who are otherwise physically fit with stage II or III disease and/or lymph node involvement, doctors generally opt to give adjuvant therapy and this means that they will provide that therapy even if they have to use a chemotherapy drug that is considered less effective than Cisplatin.

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