• Ellis P, Davies AM, Evans WK, Haynes AE, Lloyd NS, Lung Cancer Disease Site Group. The use of chemotherapy in patients with advanced malignant pleural mesothelioma: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2005 Oct 18. 47 p. (Evidence-based series; no. 7-14-1). [133 references]

Despite many reports on the use of chemotherapy in the palliative treatment of malignant pleural mesothelioma, only a limited amount of high-quality evidence exists on which to base recommendations. Based on this limited evidence, the Lung Cancer Disease Site Group instead makes the following observations and offers the following opinions:

The strongest evidence supports the use of pemetrexed 500 mg/m² and cisplatin 75 mg/m² every 3 weeks, with vitamin supplementation with B₁₂ 1000 micrograms monthly and folic acid 0.4-1.0 mg daily and is recommended for the palliative treatment of adult patients with advanced malignant pleural mesothelioma. Both vitamin supplements should be started before the administration of pemetrexed.

If pemetrexed is not available then there is weaker evidence to recommend the use of raltitrexed 3 mg/m² and cisplatin 80 mg/m² every three weeks.

The routine substitution of carboplatin for cisplatin is not recommended.

Given the very limited amount of high-quality evidence on the role of chemotherapy in malignant pleural mesothelioma, patients should be encouraged to participate in clinical trials of treatment for this disease.

None provided

The recommendations are supported by randomized controlled trials, non-comparative studies, and meta-analyses.

• Ellis P, Davies AM, Evans WK, Haynes AE, Lloyd NS, Lung Cancer Disease Site Group. The use of chemotherapy in patients with advanced malignant pleural mesothelioma: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2005 Oct 18. 47 p. (Evidence-based series; no. 7-14-1). [133 references]

Not applicable: The guideline was not adapted from another source.

2005 Oct 18

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Lung Cancer Disease Site Group

The members of the Lung Disease Site Group (DSG) disclosed potential conflicts of interest relating to the topic of this evidence summary. One of the lead authors and two Disease Site Group members reported membership on an advisory board of Eli Lilly, the pharmaceutical company that manufactures pemetrexed (Alimta®). Two Disease Site Group members reported additional involvement with Eli Lilly, including research involvement, research funding, provision of consultancy and expert testimony, ownership interests, or receipt of honoraria.

None available

This summary was completed by ECRI Institute on May 29, 2007. The information was verified by the guideline developer on June 22, 2007.