Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Mar;13(2):75-83.
doi: 10.1007/s12199-007-0016-7. Epub 2008 Feb 28.

Current therapies for malignant pleural mesothelioma

Takashi Nakano  1
Affiliations

Current therapies for malignant pleural mesothelioma

Takashi Nakano. Environ Health Prev Med. 2008 Mar.

Abstract

Mesothelioma is a highly lethal tumor derived from mesothelial cells, and its global incidence is increasing because of widespread exposure of numerous individuals to asbestos in the last 50 years. Mesothelioma is largely untreatable with any of the therapeutic modalities. Recently, a novel multitargeted antifolate pemetrexed has shown promising activity against malignant pleural mesothelioma, producing response rates of up to 40% when used in combination with cisplatin. In a large phase III study, use of a combination of pemetrexed and cisplatin was associated with significantly improved survival time and with greater antitumor activity compared with cisplatin alone. This combination also gave a significant response rate of approximately 50% in patients with epithelioid malignant pleural mesothelioma. These clinical benefits of pemetrexed-cisplatin doublet have changed the perception of mesothelioma chemotherapy. Other combinations, including gemcitabine in combination with cisplatin, have also shown encouraging response rates. Prognosis depends on gender, clinical stage of the tumor, histological subtype, platelet count, leukocyte counts, and performance status. Radiotherapy can palliate mesothelioma patients with chest pain, and has been indicated to be of benefit for the prevention of malignant seeding along the tract of a chest tube or needle biopsy. Trimodality treatment using extrapleural pneumonectomy, radiation and chemotherapy has shown promising therapeutic value. The development of chemotherapeutic regimens and the favorable outcomes of trimodality have led to new combined modality trials. In Japan, multicenter national trials against mesothelioma will begin in the near future.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Asbestos imports and annual number of deaths from mesothelioma in Japan
Fig. 2A–B
Fig. 2A–B
RECIST and modified RECIST criteria. Malignant mesothelioma of the right thoracic cavity (A); diffuse pleural thickening estimated by RECIST (dotted line), and modified RECIST (solid line). Mesothelioma of the left thoracic cavity (B); diffuse pleural thickening and multiple calcified pleural plaques, thickness estimated by RECIST (dotted line), and modified RECIST (solid line)
Fig. 3
Fig. 3
Integrated CT-PET in patient with malignant pleural mesothelioma showing diffuse uptake of FDG in right pleural tumor
See this image and copyright information in PMC

References

    1. International Mesothelioma Interest Group. A proposed new international TNM staging system for malignant pleural mesothelioma. Chest. 1995;108:1122–8. - PubMed
    1. Vogelzang NJ, Rusthoven JJ, Symanowski J, Symanowski J, Denham C, Kaukel E, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–44. - PubMed
    1. Van Meerbeeck JP, Gaafar R, Manegold C, van Klaveren RV, Van Marck EA, Vincent M, et al. Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organization for Research and Treatment of Cancer Lung-Cancer Group and the National Cancer Institute of Canada. J Clin Oncol. 2005;23:6881–9. - PubMed
    1. Martino D, Pass HI. Integration of multimodality approaches in the management of malignant pleural mesothelioma. Clin Lung Cancer. 2004;5:290–8. - PubMed
    1. Tomek S, Manegold C. Chemotherapy for malignant pleural mesothelioma: past results and recent developments. Lung Cancer. 2004;455:S103–19. - PubMed