Table of Contents Purpose of This PDQ Summary General Information Cellular Classification Stage Information Treatment Option Overview Localized Malignant Mesothelioma (Stage I)
Advanced Malignant Mesothelioma (Stages II, III, and IV) Recurrent Malignant Mesothelioma Get More Information From NCI Changes to This Summary (01/09/2009) More Information
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of malignant mesothelioma. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board 1.
Information about the following is included in this summary:
- Prognostic factors.
- Cellular classification.
- Staging.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system 2 in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version 3, written in less technical language, and in Spanish 4. General Information
Prognosis in this disease is difficult to assess consistently because there
is great variability in the time before diagnosis and the rate of disease
progression. In large retrospective series of
pleural mesothelioma patients, important prognostic factors were found to be
stage, age, performance status, and histology.[1,2] Various surgical procedures may be possible in selected patients, and they provide long-term survival without cure. For patients treated with
aggressive surgical approaches, factors associated with improved long-term
survival include epithelial histology, negative lymph nodes, and negative
surgical margins.[3,4] For those patients treated with aggressive surgical
approaches, nodal status is an important prognostic factor.[3] Median survival
has been reported as 16 months for patients with malignant pleural disease and 5 months for patients with
extensive disease. In some instances the tumor grows through the
diaphragm making the site of origin difficult to assess. Cautious
interpretation of treatment results with this disease is imperative because of
the selection differences among series. Effusions, both pleural and
peritoneal, represent major symptomatic problems for at least 66% of the
patients. (Refer to the PDQ summary on Cardiopulmonary Syndromes 5 for more information.) A history of asbestos exposure is reported in about 70% to 80% of
all cases of mesothelioma.[1,5,6]
References
-
Ruffie P, Feld R, Minkin S, et al.: Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 7 (8): 1157-68, 1989.
[PUBMED Abstract]
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Tammilehto L, Maasilta P, Kostiainen S, et al.: Diagnosis and prognostic factors in malignant pleural mesothelioma: a retrospective analysis of sixty-five patients. Respiration 59 (3): 129-35, 1992.
[PUBMED Abstract]
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Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.
[PUBMED Abstract]
-
Sugarbaker D, Harpole D, Healey E, et al.: Multimodality treatment of malignant pleural mesothelioma (MPM): results in 94 consecutive patients. [Abstract] Proceedings of the American Society of Clinical Oncology 14: A-1083, 356, 1995.
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Chailleux E, Dabouis G, Pioche D, et al.: Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients. Chest 93 (1): 159-62, 1988.
[PUBMED Abstract]
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Adams VI, Unni KK, Muhm JR, et al.: Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases. Cancer 58 (7): 1540-51, 1986.
[PUBMED Abstract]
Cellular Classification
Histologically, these tumors are composed of fibrous or epithelial elements or
both. The epithelial form occasionally causes confusion with peripheral
anaplastic lung carcinomas or metastatic carcinomas. Attempts at diagnosis by
cytology or needle biopsy of the pleura are often unsuccessful. It can be
especially difficult to differentiate mesothelioma from adenocarcinoma on small
tissue specimens. Thoracoscopy can be valuable in obtaining adequate tissue
specimens for diagnostic purposes.[1] Examination of the gross tumor at
surgery and use of special stains or electron microscopy can often help. The
special stains reported to be most useful include periodic acid-Schiff
diastase, hyaluronic acid, mucicarmine, CEA, and Leu M1.[2] Histologic
appearance seems to be of prognostic value, and most clinical studies
show that patients with epithelial mesotheliomas have a better prognosis than those with sarcomatous
or mixed histology mesotheliomas.[2-4]
References
-
Boutin C, Rey F: Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1: Diagnosis. Cancer 72 (2): 389-93, 1993.
[PUBMED Abstract]
-
Chahinian AP, Pass HI: Malignant mesothelioma. In: Holland JC, Frei E, eds.: Cancer Medicine e.5. 5th ed. Hamilton, Ontario: B.C. Decker Inc, 2000, pp 1293-1312.
-
Nauta RJ, Osteen RT, Antman KH, et al.: Clinical staging and the tendency of malignant pleural mesotheliomas to remain localized. Ann Thorac Surg 34 (1): 66-70, 1982.
[PUBMED Abstract]
-
Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.
[PUBMED Abstract]
Stage Information
Patients with stage I disease have a significantly better prognosis than those
with more advanced stages. Because of the relative rarity of this
disease, exact survival information based upon stage is limited.[1] A proposed
staging system based upon thoracic surgery principles and clinical data is
shown below.[2] It is a modification of the older system proposed by Butchart
et al.[3] Other staging systems that have been employed, including the current international TNM staging system, are summarized by the International
Mesothelioma Interest Group.[4]
- Stage I: Disease confined within the capsule of the parietal pleura
(i.e., ipsilateral pleura, lung, pericardium, and diaphragm).
- Stage II: All of stage I with positive intrathoracic (N1 or N2) lymph nodes.
- Stage III: Local extension of disease into the following areas, e.g., chest wall or
mediastinum, heart or through the diaphragm or peritoneum, with or without
extrathoracic or contralateral (N3) lymph node involvement.
- Stage IV: Distant metastatic disease.
Localized malignant mesothelioma
See description of stage I above.
Advanced malignant mesothelioma
See descriptions of stages II, III, and IV above.
For the purposes of the discussion of treatment in this summary, the disease is
categorized as either localized or advanced.
References
-
Chahinian AP, Pass HI: Malignant mesothelioma. In: Holland JC, Frei E, eds.: Cancer Medicine e.5. 5th ed. Hamilton, Ontario: B.C. Decker Inc, 2000, pp 1293-1312.
-
Sugarbaker DJ, Strauss GM, Lynch TJ, et al.: Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 11 (6): 1172-8, 1993.
[PUBMED Abstract]
-
Butchart EG, Ashcroft T, Barnsley WC, et al.: Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax 31 (1): 15-24, 1976.
[PUBMED Abstract]
-
Rusch VW: A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 108 (4): 1122-8, 1995.
[PUBMED Abstract]
Treatment Option Overview
Standard treatment for all but localized mesothelioma is generally not
curative. Although some patients will experience long-term survival with
aggressive treatment approaches, it remains unclear if overall survival (OS) has
been significantly altered by the different treatment modalities or by
combinations of modalities. Extrapleural pneumonectomy in selected patients
with early stage disease may improve recurrence-free survival, but its impact
on OS is unknown.[1] Pleurectomy and decortication can provide
palliative relief from symptomatic effusions, discomfort caused by tumor
burden, and pain caused by invasive tumor. (Refer to the PDQ summary on Pain 6 for more information.) Operative mortality from
pleurectomy/decortication is less than 2%,[2] while mortality from extrapleural
pneumonectomy has ranged from 6% to 30%.[1,3] The addition of radiation
therapy and/or chemotherapy following surgical intervention has not
demonstrated improved survival.[2] The use of radiation therapy in pleural
mesothelioma has been shown to alleviate pain in the majority of patients
treated; however, the duration of symptom control is short-lived.[4,5] Single-agent and combination chemotherapy have been evaluated in single and combined
modality studies. The most studied agent is doxorubicin, which has produced
partial responses in approximately 15% to 20% of patients studied.[6] Some
combination chemotherapy regimens have been reported to have higher response
rates in small phase II trials; however, the toxic effects reported are also higher,
and there is no evidence that combination regimens result in longer survival or
longer control of symptoms.[6,7]. Recurrent pleural effusions may be treated
with pleural sclerosing procedures; however, failure rates are usually
secondary to the bulk of the tumor, which precludes pleural adhesion due to the
inability of the lung to fully expand.
References
-
Rusch VW, Piantadosi S, Holmes EC: The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial. J Thorac Cardiovasc Surg 102 (1): 1-9, 1991.
[PUBMED Abstract]
-
Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
[PUBMED Abstract]
-
Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
[PUBMED Abstract]
-
Bissett D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol (R Coll Radiol) 3 (6): 315-7, 1991.
[PUBMED Abstract]
-
Ball DL, Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. Am J Clin Oncol 13 (1): 4-9, 1990.
[PUBMED Abstract]
-
Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntingt) 3 (1): 67-72; discussion 73-4, 77, 1989.
[PUBMED Abstract]
-
Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.
[PUBMED Abstract]
Localized Malignant Mesothelioma (Stage I)
Standard treatment options:[1]
- Solitary mesotheliomas: Surgical resection en bloc including contiguous
structures to ensure wide disease-free margins. Sessile polypoid lesions
should be treated with surgical resection to ensure maximal potential for
cure.[2]
- Intracavitary mesothelioma:
- Palliative surgery (i.e., pleurectomy and decortication) with or without
postoperative radiation therapy.
- Extrapleural pneumonectomy.
- Palliative radiation therapy.
Treatment options under clinical evaluation:
- Intracavitary chemotherapy following resection.[3,4]
- Multimodality therapy.[4-6]
- Other clinical trials.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized malignant mesothelioma 7. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Antman KH, Li FP, Osteen R, et al.: Mesothelioma. Cancer: Principles and Practice of Oncology Updates 3(1): 1-16, 1989.
-
Martini N, McCormack PM, Bains MS, et al.: Pleural mesothelioma. Ann Thorac Surg 43 (1): 113-20, 1987.
[PUBMED Abstract]
-
Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 118 (7): 547-50, 1992.
[PUBMED Abstract]
-
Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
[PUBMED Abstract]
-
Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
[PUBMED Abstract]
-
Vogelzang NJ: Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 19 (4 Suppl 11): 64-71, 1992.
[PUBMED Abstract]
Advanced Malignant Mesothelioma (Stages II, III, and IV)
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence 2 for more
information.)
Standard treatment options:
- Symptomatic treatment to include drainage of effusions, chest tube
pleurodesis, or thoracoscopic pleurodesis.[1] (Refer to the PDQ summary on Cardiopulmonary Syndromes 5 for more information.)
- Palliative surgical resection in selected patients.[2,3]
- Palliative radiation therapy.[4,5]
- Single-agent chemotherapy. Partial responses have been reported with
doxorubicin, epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin,
and ifosfamide.[6-8]
- Combination chemotherapy (under clinical evaluation).[6,7,9] Information
about ongoing clinical trials is available from the NCI
Web site 9.
- Multimodality clinical trials.[10-14]
- Intracavitary therapy. Intrapleural or intraperitoneal administration of
chemotherapeutic agents (e.g., cisplatin, mitomycin, and cytarabine) has been
reported to produce transient reduction in the size of tumor masses and
temporary control of effusions in small clinical studies.[15-17] Additional
studies are needed to define the role of intracavitary therapy.
Many phase II trials of chemotherapy have been reported.[6,7,9] The safety and efficacy of pemetrexed, an antifolate, and cisplatin in chemotherapy-naive patients with malignant mesothelioma who were not eligible for curative surgery was demonstrated in a randomized phase III trial.[18][Level of evidence: 1iiA] This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 on day 1) with cisplatin alone (75 mg/m2 on day 1 intravenously every 21 days). With a total of 456 enrolled patients in the trial, 226 patients received pemetrexed plus cisplatin, 222 patients received cisplatin alone, and 8 patients did not receive therapy. After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxic effects. Folic acid (350–1,000 µg orally) was given daily, beginning 1 to 3 weeks before the first chemotherapy dose and continuing daily until 1 to 3 weeks after treatment ended. A vitamin B12 injection (1,000 µg intramuscularly) was administered 1 to 3 weeks before the first chemotherapy dose and was repeated approximately every 9 weeks until treatment ended. Dexamethasone (4 mg) or an equivalent corticosteroid was administered orally twice daily for skin rash prophylaxis to all patients 1 day before, on the day of, and 1 day after each pemetrexed dose.
In an analysis of all patients who were randomized and treated, the combination of pemetrexed and cisplatin was associated with a statistically significant improvement in survival compared with cisplatin alone; the median survivals were 12.1 versus 9.3 months, respectively (P = .020). The hazard ratio for death of patients in the pemetrexed plus cisplatin arm versus those in the control arm was 0.77. Median time-to-progression was significantly longer in the pemetrexed plus cisplatin arm (5.7 months vs. 3.9 months, P = .001). This superiority in the combination arm was also demonstrated in the vitamin-supplemented subgroup. The median survivals were 13.3 and 10.0 months in the combination group and cisplatin alone group, respectively (P = .051). The principal adverse effects of the pemetrexed plus cisplatin regimen were myelosuppression, fatigue, nausea, vomiting, and dyspnea. Most grade 3 to 4 adverse effects were significantly reduced by vitamin supplementation without any decrease in efficacy.
A randomized phase III trial of 250 patients was performed by the European Organisation for Research and Treatment of Cancer (EORTC-08983 10) to compare cisplatin alone with the combination of raltitrexed, a thymidine synthase inhibitor, and cisplatin in first-line treatment of patients with malignant pleural mesothelioma.[19] Cisplatin (80 mg/m2 IV) was given on day 1, alone or combined with raltitrexed (3 mg/m2). No toxic deaths resulted, and the main grade 3 or 4 toxicities observed were neutropenia and emesis, which were reported twice as often in the combination arm. Among 213 patients with measurable disease, the response rate was 13.6% versus 23.6%, respectively (P = .056). No difference in quality of life was observed. The combination arm was associated with an increased survival. Median overall and 1-year survival were 8.8 versus 11.4 months, respectively and 40% versus 46%, respectively (P = .048).[19][Level of evidence: 1iiA]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with advanced malignant mesothelioma 11. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Boutin C, Viallat JR, Rey R: Thoracoscopy in Diagnosis, Prognosis and Treatment of Mesothelioma. In: Antman K, Aisner J, eds.: Asbestos-Related Malignancy. Orlando,Fla: Grune & Stratton, 1987, pp 301-21.
-
Butchart EG, Ashcroft T, Barnsley WC, et al.: The role of surgery in diffuse malignant mesothelioma of the pleura. Semin Oncol 8 (3): 321-8, 1981.
[PUBMED Abstract]
-
Martini N, McCormack PM, Bains MS, et al.: Pleural mesothelioma. Ann Thorac Surg 43 (1): 113-20, 1987.
[PUBMED Abstract]
-
Bissett D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clin Oncol (R Coll Radiol) 3 (6): 315-7, 1991.
[PUBMED Abstract]
-
Ball DL, Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. Am J Clin Oncol 13 (1): 4-9, 1990.
[PUBMED Abstract]
-
Chahinian AP, Antman K, Goutsou M, et al.: Randomized phase II trial of cisplatin with mitomycin or doxorubicin for malignant mesothelioma by the Cancer and Leukemia Group B. J Clin Oncol 11 (8): 1559-65, 1993.
[PUBMED Abstract]
-
Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.
[PUBMED Abstract]
-
Lerner HJ, Schoenfeld DA, Martin A, et al.: Malignant mesothelioma. The Eastern Cooperative Oncology Group (ECOG) experience. Cancer 52 (11): 1981-5, 1983.
[PUBMED Abstract]
-
Andreopoulou E, Ross PJ, O'Brien ME, et al.: The palliative benefits of MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in patients with malignant mesothelioma. Ann Oncol 15 (9): 1406-12, 2004.
[PUBMED Abstract]
-
Mattson K, Holsti LR, Tammilehto L, et al.: Multimodality treatment programs for malignant pleural mesothelioma using high-dose hemithorax irradiation. Int J Radiat Oncol Biol Phys 24 (4): 643-50, 1992.
[PUBMED Abstract]
-
Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntingt) 3 (1): 67-72; discussion 73-4, 77, 1989.
[PUBMED Abstract]
-
Vogelzang NJ: Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol 19 (4 Suppl 11): 64-71, 1992.
[PUBMED Abstract]
-
Sugarbaker D, Harpole D, Healey E, et al.: Multimodality treatment of malignant pleural mesothelioma (MPM): results in 94 consecutive patients. [Abstract] Proceedings of the American Society of Clinical Oncology 14: A-1083, 356, 1995.
-
Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103 (4 Suppl): 377S-381S, 1993.
[PUBMED Abstract]
-
Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 118 (7): 547-50, 1992.
[PUBMED Abstract]
-
Markman M, Cleary S, Pfeifle C, et al.: Cisplatin administered by the intracavitary route as treatment for malignant mesothelioma. Cancer 58 (1): 18-21, 1986.
[PUBMED Abstract]
-
Rusch VW, Figlin R, Godwin D, et al.: Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial. J Clin Oncol 9 (2): 313-9, 1991.
[PUBMED Abstract]
-
Vogelzang NJ, Rusthoven JJ, Symanowski J, et al.: Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21 (14): 2636-44, 2003.
[PUBMED Abstract]
-
van Meerbeeck JP, Gaafar R, Manegold C, et al.: Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol 23 (28): 6881-9, 2005.
[PUBMED Abstract]
Recurrent Malignant Mesothelioma
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence 2 for more
information.)
Treatment of patients with recurrent mesothelioma usually utilizes procedures and/or agents
not previously employed in the initial treatment attempt. No standard
treatment approaches have been proven to improve survival or control symptoms
for a prolonged period of time. These patients should be considered candidates
for phase I and II clinical trials evaluating new biologicals, chemotherapeutic
agents, or physical approaches.[1-5] Patients with recurrent mesothelioma who have not received prior chemotherapy are candidates for first-line chemotherapy with cisplatin pemetrexed or cisplatin raltitrexed. (Refer to the Advanced Malignant Mesothelioma (Stages II, III, and IV) 12 section of this summary.) However, patients with recurrent mesothelioma who receive surgery, or at least do not receive chemotherapy as part of the primary treatment and recur subsequently, are candidates for chemotherapy.
A large randomized study compared pemetrexed to best supportive care in 243 patients who received one prior regimen of chemotherapy that did not include pemetrexed.[6][Level of evidence: 1iiA] No survival benefit was shown in patients who received pemetrexed, although the progression-free survival rate, time-to-progression, and the response rates favored the pemetrexed arm.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent malignant mesothelioma 13. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site 8.
References
-
Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12 (6): 1156-63, 1994.
[PUBMED Abstract]
-
Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. J Cancer Res Clin Oncol 118 (7): 547-50, 1992.
[PUBMED Abstract]
-
Zucali PA, Ceresoli GL, Garassino I, et al.: Gemcitabine and vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma. Cancer 112 (7): 1555-61, 2008.
[PUBMED Abstract]
-
Boutin C, Viallat JR, Van Zandwijk N, et al.: Activity of intrapleural recombinant gamma-interferon in malignant mesothelioma. Cancer 67 (8): 2033-7, 1991.
[PUBMED Abstract]
-
Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma. A review. J Clin Oncol 14 (3): 1007-17, 1996.
[PUBMED Abstract]
-
Jassem J, Ramlau R, Santoro A, et al.: Phase III trial of pemetrexed plus best supportive care compared with best supportive care in previously treated patients with advanced malignant pleural mesothelioma. J Clin Oncol 26 (10): 1698-704, 2008.
[PUBMED Abstract]
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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Advanced Malignant Mesothelioma (Stages II, III, and IV) 12
Added text 17 about a randomized phase III trial that compared cisplatin alone with the combination of raltitrexed and cisplatin in first-line treatment of patients with malignant pleural mesothelioma (cited van Meerbeeck et al. as reference 19 and level of evidence 1iiA).
Recurrent Malignant Mesothelioma 18
Added Zucali et al. as reference 3 19. Added text 19 to state that patients with recurrent mesothelioma but without prior chemotherapy are candidates for first-line chemotherapy with cisplatin pemetrexed or cisplatin raltitrexed; patients who receive surgery without chemotherapy and recur are candidates for chemotherapy.
Added text 20 about a study that compared pemetrexed to best supportive care in patients who received one prior regimen of chemotherapy without pemetrexed (cited Jassem et al. as reference 6 and level of evidence 1iiA). More Information
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