Chemotherapy for malignant pleural mesothelioma

Our plain-English summary of Chemotherapy for malignant pleural mesothelioma, by L.L. Garland (Current Treatment Options in Oncology, 2011).

The study

• Author: L.L. Garland
• Journal: Current Treatment Options in Oncology
• Published: 2011;12(2):181-8
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

All MPM patients with a good performance status should be considered for enrollment on clinical trials. With that said, the standard frontline therapy for fit MPM patients remains an antifolate/platinum doublet, based on large, well powered randomized clinical trials that showed not only a survival benefit for antifolate/platinum regimens but also improvements in quality of life and/or symptoms. For less fit patients, single agents can be used as frontline therapy. In the second line setting, there is benefit from retreatment with single agent pemetrexed after prior exposure to that agent, as well as after exposure to other chemotherapeutic agents. Other single chemotherapy agents and combinations are viable options for fit patients who have had relatively long time to progression after their frontline therapy. Additionally, several prognostic scales designed for MPM (CALGB and EORTC) provide additional means to better select patients for frontline and second line chemotherapy.

In plain English

This article was a review and opinion piece by a single author on chemotherapy for malignant pleural mesothelioma (MPM). It reported no new patient data and did not discuss asbestos exposure. It summarized published clinical trials and case series. Among the studies it described, a phase III trial of 456 patients reported median overall survival of 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone. A phase III trial of raltitrexed plus cisplatin reported 11.4 versus 8.8 months with cisplatin alone. The article stated that median survival with the best current first-line treatment was in the range of 12–15 months. For second-line treatment, it described a case series of 31 patients retreated with pemetrexed-based therapy, which reported median overall survival of 10.5 months. The author concluded that the standard first-line treatment for fit patients remained a combination of an antifolate drug and a platinum drug, and that single drugs could be used for less fit patients. The author also concluded that retreatment with pemetrexed offered benefit. The author disclosed payment from Eli Lilly for developing educational presentations.

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 with opinion statement (no original data)
• Who was studied: No study population of its own; the article reviewed published case series, phase II studies and phase III trials of chemotherapy in patients with malignant pleural mesothelioma
• Exposure: Chemotherapy drugs for MPM (e.g. pemetrexed, raltitrexed, cisplatin, carboplatin, vinorelbine, gemcitabine); asbestos exposure is not discussed
• Main results:
  • In a cited phase III trial of 456 patients, median overall survival was 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone
  • In a cited phase III trial, median survival was 11.4 months with raltitrexed plus cisplatin versus 8.8 months with cisplatin alone
  • The author stated that median survival with state-of-the-art first-line therapy was 12–15 months
  • In a cited trial of 243 previously treated patients, median progression-free survival was 3.6 months with pemetrexed plus best supportive care versus 1.5 months with best supportive care alone, and median time to progression was 3.7 versus 1.5 months
  • In a cited trial of 409 previously untreated patients, median overall survival was 7.6 months with active symptom control alone and 8.5 months with active symptom control plus chemotherapy; the article described this survival benefit as small and not statistically significant
  • In a cited case series of 31 patients retreated with pemetrexed-based therapy, median progression-free survival was 3.8 months and median overall survival was 10.5 months
• The authors' conclusion: The author concluded that an antifolate/platinum doublet remained standard first-line therapy for fit MPM patients, that single agents could be used for less fit patients, and that retreatment with pemetrexed offered benefit in the second-line setting

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, Pleural Mesothelioma, Performance Status, Clinical Trial, Antifolate, Quality of Life, Pemetrexed (Alimta).

Related studies

• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Combined chemotherapy with cytotoxic and targeted compounds for the management of human malignant pleural mesothelioma — R.E. Favoni, T. Florio (2011)
• Continued pemetrexed and platin-based chemotherapy in patients with malignant pleural mesothelioma (MPM): value of 18F-FDG-PET/CT — N.G. Schaefer, P. Veit-Haibach, et al. (2012)
• Correlation between TS, MTHFR, and ERCC1 gene polymorphisms and the efficacy of platinum in combination with pemetrexed first-line chemotherapy in mesothelioma patients — T. Powrózek, D.M. Kowalski, et al. (2014)

Browse more research in Current Treatment Options in Oncology, or return to medical research.