Evidence was identified through a systematic search of MEDLINE (1966 through October 2005), EMBASE (1980 through October 2005), CANCERLIT (1966 to March 2002), and the Cochrane Library databases (2005, Issue 3). Search terms used included "mesothelioma", (Medical subject heading (MeSH) and Excerpta Medica Tree (EMTREE) term) with and without the subheading "drug therapy", combined with "drug therapy" (MeSH), "chemotherapy, adjuvant" (MeSH), and "antineoplastic agents" (MeSH), "chemotherapy" (EMTREE), "adjuvant therapy" (EMTREE), and the text word "mesothelioma". Those terms were combined with the search terms for the following study designs and publication types: practice guidelines, systematic reviews, meta-analyses, randomized controlled trials, controlled clinical trials, phase II or III clinical trials, and multicenter or comparative studies.
In addition, conference proceedings of the American Society of Clinical Oncology (ASCO) for the years 1997-2005 were searched for abstracts of relevant trials. The Canadian Medical Association Infobase (http://mdm.ca/cpgsnew/cpgs/index.asp) and the National Guideline Clearinghouse (http://www.guideline.gov) were also searched for existing evidence-based practice guidelines.
Relevant articles and abstracts were selected and reviewed by two reviewers and the reference lists from these sources were searched for additional trials, as were the reference lists from relevant review articles.
Inclusion Criteria
Articles published as full reports or as abstracts were selected for inclusion in this systematic review of the evidence if they were:
- Practice guidelines, systematic reviews, or meta-analyses evaluating the use of chemotherapy for malignant pleural mesothelioma (MPM).
- Randomized clinical trials (RCTs) comparing chemotherapy with best supportive care (BSC), or different chemotherapy regimens.
- Phase II clinical trials evaluating chemotherapy, either as single agents or combinations of agents.
- Phase II clinical trials evaluating chemotherapy (single-agent or in combination) combined with immunotherapies such as interferon and interleukin, and if they met the following criteria:
- Study population included patients with MPM. Studies including patients with both pleural and peritoneal malignant mesothelioma were also eligible.
- Outcomes of response, survival, quality of life (QOL), or symptom control were reported.
Exclusion Criteria
The following were excluded from the systematic review:
- Papers published in a language other than English.
- Clinical trials primarily assessing immunotherapies.
- Trials of chemotherapy combined with surgery and/or radiation therapy.
The literature search for phase II trials was not updated after April 2002 as there were data from large randomized trials on which to make treatment recommendations.