Editing Treatment Options (section)

== What Chemotherapy Options Are Available for Mesothelioma? ==

[https://mesothelioma.net/mesothelioma-chemotherapy/ Mesothelioma chemotherapy] remains foundational to treatment, with the pemetrexed plus cisplatin combination established as the standard backbone since 2003.

=== What Is First-Line Chemotherapy? ===

First-line chemotherapy refers to the initial drug regimen used to treat mesothelioma, typically combining pemetrexed 500 mg/m² with cisplatin 75 mg/m² administered intravenously every 21 days for 4-6 cycles. This combination achieves response rates of 41.3% with median overall survival of 12.1 months.

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| style="padding:15px; color:#856404;" | '''⚠️ Critical Supportive Care:''' Patients must receive folic acid (350-1000 μg daily) and vitamin B12 (1000 μg intramuscularly every 9 weeks) starting 3 weeks before chemotherapy begins. These supplements prevent severe toxicity and must continue throughout treatment.
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'''Chemotherapy Cost Breakdown:'''

Standard 6-cycle cisplatin/pemetrexed course: $38,779-$40,102

With bevacizumab addition: $87,741 plus $8,160 monthly maintenance

Second-line options (gemcitabine, vinorelbine): $20,000-$40,000

Administration and monitoring per cycle: $2,500-$6,000 beyond drug costs

The MAPS trial demonstrated that adding bevacizumab 15 mg/kg every 3 weeks extends median overall survival to 18.8 months versus 16.1 months (HR 0.77, p=0.0167), though this combination lacks FDA approval and requires [https://www.mesotheliomalawyercenter.org/entity/mesothelioma/ insurance authorization] as off-label use.

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