Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy is chemotherapy given before the main treatment, usually surgery, rather than after it. The goal is to shrink the tumor, kill cancer cells that may have already spread, and make the planned surgery more effective. In mesothelioma, it is most often used before pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP).

Origin

The word "neoadjuvant" combines the Greek "neo-" (new) with the Latin "adjuvare" (to help). The concept emerged in oncology in the 1970s and 1980s as researchers found that giving chemotherapy before surgery could improve outcomes in several cancers, including breast and bladder cancer, and was later adapted to mesothelioma trimodality protocols in the 1990s and 2000s.

Significance in Asbestos Context

For patients with pleural mesothelioma who are candidates for surgery, neoadjuvant chemotherapy is often the first step in a multi-part treatment plan known as multimodality or trimodality therapy (chemotherapy + surgery + sometimes radiation or immunotherapy). The most common regimen is cisplatin (or carboplatin) combined with pemetrexed, given over several cycles before surgery. How well the tumor responds to this chemotherapy can influence whether surgery proceeds, what type of operation is done, and the patient's overall prognosis. Records of the regimen used, the number of cycles completed, imaging response, and side effects are important parts of the medical file and may also be relevant to a legal claim because they document the severity of the disease and the burden of treatment.

Example Sentence

Her oncologist recommended four cycles of neoadjuvant chemotherapy with cisplatin and pemetrexed before scheduling the pleurectomy/decortication.

Related Terms

Adjuvant Chemotherapy, Pemetrexed, Cisplatin, Pleurectomy/Decortication, Extrapleural Pneumonectomy, Multimodality Therapy

Notes

• Ask your oncologist exactly which drugs, doses, and number of cycles are planned, and request copies of the treatment summary and imaging reports (CT or PET) taken before and after chemotherapy to document response.
• Ask about side effects to watch for (kidney function changes, low blood counts, fatigue, neuropathy, and nausea) and what supportive medications (anti-nausea drugs, growth factors, hydration) will be used.
• If surgery is part of the plan, ask how the decision to proceed will be made: what imaging response, performance status, or lab results are required, and what happens if the tumor does not respond as hoped.
• Keep a personal log of treatment dates, hospitalizations, and missed work. This documentation supports both medical care coordination and damages in a legal claim.
• Ask whether a clinical trial combining neoadjuvant chemotherapy with immunotherapy (such as nivolumab or pembrolizumab) is appropriate, as combination approaches are an active area of mesothelioma research.