Chemotherapy treatment in malignant pleural mesothelioma: a difficult history

Abstract

Malignant pleural mesothelioma (MPM) is a rare neoplasm that typically arises from mesothelial surfaces of the pleural cavity. Despite treatment improvements, it carries a dismal prognosis. The majority of patients either have unresectable disease or are not candidates for surgery due to medical comorbidities or old age. For such patients, chemotherapy (CT) represents the gold-standard treatment. To date, combination CT with cisplatin plus pemetrexed represents the most widely used regimen in first-line setting for patients with unresectable MPM. Other first-line options are currently available, including the use of raltitrexed instead of pemetrexed combined with platinum. In this review, we discuss the role of CT in MPM mainly focusing on the results of the trials conducted in first-line setting.

Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease

“…Standard systemic anticancer treatment for MPM includes chemotherapy, usually a platinum compound in addition to the folate antimetabolite, pemetrexed [7][8][9]. Other chemotherapy options include vinorelbine although response rates in the second line setting and onwards are poor.…”

Tratamento Quimioterápico do Mesotelioma Pleural Maligno: Revisão Sistemática

“…Uma proporção pequena de pacientes é candidata ao manuseio cirúrgico e, para a maioria dos pacientes, as opções disponíveis incluem a quimioterapia, radioterapia ou tratamento de suporte. Entretanto, persistem debates sobre o esquema quimioterápico ideal, com uma variedade de agentes isolados ou em combinação sendo testados e, mais recentemente, sendo exploradas estratégias à base de imunoterapia 22 .…”

“…Nos demais estudos, esquemas baseados em cisplatina e pemetrexede associados a um terceiro antineoplásico apresentaram os maiores tempos de sobrevida global. A associação de bevacizumabe, cisplatina e pemetrexede (18,8 meses, IC 95% (15,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)6), no estudo de Zalcman et al 16 , mostrou que os participantes possuíam melhor condição clínica e podiam utilizar o pemetrexede como terapia de manutenção 16 . Esse estudo possuiu 448 pacientes, com idade inferior a 76 anos e com menos de 10% apresentando performance status 2.…”

<p>Pain management in patients with malignant mesothelioma: challenges and solutions</p>

“…Unfortunately, most MPM patients progress following first-line chemotherapy. No optimum regimen has yet been identified for second-line treatment 57…”