Chemotherapy for malignant mesothelioma: from doxorubicin to vinorelbine

Our plain-English summary of Chemotherapy for malignant mesothelioma: from doxorubicin to vinorelbine, by P. Baas (Seminars in Oncology, 2002).

The study

• Author: P. Baas
• Journal: Seminars in Oncology
• Published: 2002;29(1):62-9
• Type of article: Review
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

It has been a challenge to find effective chemotherapeutic treatments for malignant mesothelioma. Over the last several decades numerous single-drug and combination regimens have been examined, but no standard treatment with chemotherapy alone has emerged. Possible explanations for this lack of success are the heterogeneity between the different subclasses of mesothelioma and the difficulties experienced in determining responses on computed tomographic (CT) scan. This review will present the results of most chemotherapy trials. An attempt is also been made to overcome the problem of identifying the overall response rate by presenting the median survival time. Other types of response evaluation and guidelines for patient selection are warranted to properly compare chemotherapeutic treatments.

Copyright 2002 by W.B. Saunders Company.

In plain English

This article reviewed published chemotherapy trials for malignant pleural mesothelioma, covering single drugs and combinations. The author stated that only studies with 15 or more patients, proper statistical analysis and documented histology would be presented. The author wrote that some single drugs, including anthracyclines, high-dose methotrexate and cisplatin, had reported response rates of 10% to 20%, though one reviewed high-dose methotrexate study reported 2% complete and 35% partial responses. The author gave response-rate ranges of 3% to 26% for anthracyclines and 5% to 14% for platinum drugs, but one reviewed carboplatin study reported 16% in 31 patients. In one reviewed vinorelbine study, 7 of 29 patients (24%) had a partial response. The author put combination response rates at 0% to 44%, with generally disappointing median survival, although the combination table listed 48% for cisplatin plus gemcitabine in 21 patients. The author noted that many earlier studies were small and poorly designed, and that measuring tumor response after treatment is difficult. The author concluded that chemotherapy, as then available, could not be advised as the only treatment outside clinical trials.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published chemotherapy trials (single agents and combinations) in malignant mesothelioma
• Who was studied: Published chemotherapy studies in patients with malignant pleural mesothelioma. The author limited the review to studies with 15 or more patients, proper statistical analyses and documented histology.
• Exposure: Chemotherapy drugs given alone or in combination, including anthracyclines, platinum analogs, antimetabolites, taxanes, vinca alkaloids and others. Asbestos exposure was not a subject of the review.
• Main results:
  • The author's general statement was that activity of single agents was low, but some had reported overall response rates in the range of 10% to 20%. The author named anthracyclines, high-dose methotrexate and cisplatin as examples.
  • In a reviewed high-dose methotrexate study of 63 patients, 2% had a complete response and 35% a partial response. A further 32% had no change and 32% had progressive disease.
  • The author gave a response-rate range of 3% to 26% for reviewed anthracycline studies.
  • In a reviewed Eastern Cooperative Oncology Group retrospective analysis of doxorubicin-containing protocols, objective regression was seen in 12 (12%) of 96 patients.
  • The author gave a response-rate range of 5% to 14% for reviewed platinum studies.
  • Some individual platinum studies described in the review reported higher rates. In an Australian carboplatin study, the response rate was 16% in 31 patients.
  • In a reviewed weekly cisplatin study, 5 of 14 patients (36%) had an objective partial response lasting 2 to 8 months.
  • In a reviewed vinorelbine study of 29 patients, 7 (24%) had a partial response and 16 (55%) had stable disease. Median survival from the start of treatment was 10.6 months.
  • The author stated that response rates for reviewed combination regimens ranged from 0% to 44%. The author described median survival in these regimens as generally disappointing.
  • The combination table listed a 48% response rate for cisplatin plus gemcitabine given every 4 weeks in 21 patients.
• The authors' conclusion: The author concluded that chemotherapy, as then available, could not be advised as a single-treatment approach outside of clinical trials.
• Limitations the authors state:
  • The author stated that many phase II studies in this disease were poorly designed and had too few patients.
  • The author stated that measuring response after treatment is a major problem in malignant pleural mesothelioma.
  • The author stated that older studies did not routinely review pathology to exclude patients with adenocarcinoma of the pleura.
  • The author stated that response rates for the same drug varied widely between research groups, so patients treated with comparable schedules were pooled.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Malignant Mesothelioma, Doxorubicin, Vinorelbine, Mesothelioma, Median Survival.

Related studies

• Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy — G. Toyokawa, M. Takenoyama, et al. (2014)
• Vinorelbine and gemcitabine as second- or third-line therapy for malignant pleural mesothelioma — M.G. Zauderer, S.L. Kass, et al. (2014)
• Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma — P.A. Zucali, M. Perrino, et al. (2014)
• A dose-finding study of gemcitabine and vinorelbine in advanced previously treated malignancies — J.P. Delord, E. Raymond, et al. (2000)
• Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed — T. Agatsuma, T. Koizumi, et al. (2010)
• Triplet chemotherapy with cisplatin, gemcitabine and vinorelbine for malignant pleural mesothelioma — R. Maruyama, F. Shoji, et al. (2005)

Browse more research in Seminars in Oncology, or return to medical research.