Mesothelioma Update

By Mark Block, MD; and Alice M. Boylan, MD

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Chemotherapy

Many different chemotherapeutic agents have been tried alone and in combination with limited success. It is difficult to interpret clinical trials because the number of patients is usually small and there is a lack of uniformity in staging. An extensive review of chemotherapy trials by Ryan et al²¹ that covers studies up to the late 1990s is very helpful. They concluded that the highest antitumor activity was demonstrated with the antimetabolites, small activity is seen with platinum compounds, and even less with plant alkaloids. They also found no evidence that combination chemotherapies provided survival benefit over single-agent chemotherapy.
Since that review, two trials using cisplatin in combination with gemcitabine²² or irinotecan²³ have been reported. Both demonstrated that a significant number of patients had improvement in symptoms, but there was no significant improvement in survival.

Recently, there has been considerable excitement about the use of two new antifolates, pemetrexed and raltitrexed, in mesothelioma. These agents, used in combination with platinum-based compounds, have shown promise in phase I and II studies, with a significant number of patients showing objective responses. Phase III trials are in progress to determine if the use of these agents alone or in combination is associated with improved survival.²⁴

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