Revision as of 18:33, 6 October 2015

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19 regimens on this page 33 variants on this page

First-line therapy

Active symptom control

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Regimen

Study	Evidence	Comparator
Muers et al. (MS01)	Phase III	MVP Vinorelbine

No antineoplastic treatment; used as a comparator arm and here for reference purposes only.

References

Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CM, Lowry E, Nicholson AG, O'Brien M, Peake M, Rudd R, Snee M, Steele J, Girling DJ, Nankivell M, Pugh C, Parmar MK; MS01 Trial Management Group. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet. 2008 May 17;371(9625):1685-94. link to PMC article contains verified protocol PubMed

Carboplatin & Pemetrexed

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Regimen


Study	Evidence
Ceresoli et al. 2006	Phase II
Castagneto et al. 2007	Phase II

Carboplatin (Paraplatin) AUC 5 IV over 30 minutes on day 1, given second, 30 minutes after pemetrexed
Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes on day 1, given first

Supportive medications (varies depending on reference):

Folic acid 350-600 mcg PO daily, starting at least 1 week before Pemetrexed (Alimta), to continue throughout therapy
Cyanocobalamin (Vitamin B12) 1000 mcg IM once at least 1 week before Pemetrexed (Alimta), then 1000 mcg to be given every 9 weeks thereafter
Dexamethasone (Decadron) 4 mg PO BID the day before, the day of, and day after Pemetrexed (Alimta)
- Alternatively, Dexamethasone (Decadron) may be given 8 mg IM the day before, the day of, and day after Pemetrexed (Alimta)
No NSAIDs (nonsteroidal anti-inflammatory drugs) for 2 days (5 days for NSAIDs with longer half-lives) before or after Pemetrexed (Alimta)

21-day cycles; up to 9 cycles in Castagneto et al. 2008

References

Ceresoli GL, Zucali PA, Favaretto AG, Grossi F, Bidoli P, Del Conte G, Ceribelli A, Bearz A, Morenghi E, Cavina R, Marangolo M, Parra HJ, Santoro A. Phase II study of pemetrexed plus carboplatin in malignant pleural mesothelioma. J Clin Oncol. 2006 Mar 20;24(9):1443-8. link to original article contains verified protocol PubMed
Castagneto B, Botta M, Aitini E, Spigno F, Degiovanni D, Alabiso O, Serra M, Muzio A, Carbone R, Buosi R, Galbusera V, Piccolini E, Giaretto L, Rebella L, Mencoboni M. Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma (MPM). Ann Oncol. 2008 Feb;19(2):370-3. Epub 2007 Dec 20. link to original article contains verified protocol PubMed

Cisplatin (Platinol)

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Regimen

Study	Evidence	Comparator
Vogelzang et al. 2003	Phase III	Cisplatin & Pemetrexed

Cisplatin (Platinol) 75 mg/m2 IV over 2 hours on day 1

21-day cycles

References

Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003 Jul 15;21(14):2636-44. link to original article contains verified protocol PubMed
1. Update: Manegold C, Symanowski J, Gatzemeier U, Reck M, von Pawel J, Kortsik C, Nackaerts K, Lianes P, Vogelzang NJ. Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural mesothelioma. Ann Oncol. 2005 Jun;16(6):923-7. Epub 2005 Apr 11. link to original article PubMed

Cisplatin & Gemcitabine

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Regimen #1

Study	Evidence
Nowak et al. 2002	Phase II

Cisplatin (Platinol) 100 mg/m2 IV over 1 hour on day 1, given first
Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes once per day on days 1, 8, 15, given second

Supportive medications:

Minimum of 3 liters of IV hydration for Cisplatin (Platinol), with magnesium supplementation
5HT-3 antagonists & Dexamethasone (Decadron) IV once per day on days 1, 8, 15 before chemotherapy
5HT-3 antagonists, Dexamethasone (Decadron), and/or phenothiazines for antiemesis PO or by rectal suppository for 3 to 5 days after Cisplatin (Platinol)

28-day cycle x up to 6 cycles

Regimen #2

Study	Evidence
van Haarst et al. 2002	Phase II

Cisplatin (Platinol) 80 mg/m2 IV over 3 hours on day 1, given second
Gemcitabine (Gemzar) 1250 mg/m2 IV over 30 minutes once per day on days 1 & 8, given first

Supportive medications:

Minimum of 2 liters of IV hydration for Cisplatin (Platinol)
5HT-3 antagonists & corticosteroids before Cisplatin (Platinol)

21-day cycle x up to 6 cycles

References

van Haarst JM, Baas P, Manegold Ch, Schouwink JH, Burgers JA, de Bruin HG, Mooi WJ, van Klaveren RJ, de Jonge MJ, van Meerbeeck JP. Multicentre phase II study of gemcitabine and cisplatin in malignant pleural mesothelioma. Br J Cancer. 2002 Feb 1;86(3):342-5. link to original article contains verified protocol PubMed content property of HemOnc.org
Nowak AK, Byrne MJ, Williamson R, Ryan G, Segal A, Fielding D, Mitchell P, Musk AW, Robinson BW. A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma. Br J Cancer. 2002 Aug 27;87(5):491-6. link to original article contains verified protocol PubMed

Cisplatin & Pemetrexed

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Regimen

Study	Evidence	Comparator
Vogelzang et al. 2003	Phase III	Cisplatin

Cisplatin (Platinol) 75 mg/m2 IV over 2 hours on day 1, given second, 30 minutes after pemetrexed
Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes on day 1, given first

Supportive medications:

Folic acid 350-1000 mcg PO daily, starting 1 to 3 weeks before Pemetrexed (Alimta), to continue throughout therapy
Cyanocobalamin (Vitamin B12) 1000 mcg IM once 1 to 3 weeks before Pemetrexed (Alimta), then 1000 mcg to be given every 9 weeks thereafter
Dexamethasone (Decadron) (dose not specified by reference) the day before, the day of, and day after Pemetrexed (Alimta)

21-day cycles

References

Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003 Jul 15;21(14):2636-44. link to original article contains verified protocol PubMed
1. Update: Manegold C, Symanowski J, Gatzemeier U, Reck M, von Pawel J, Kortsik C, Nackaerts K, Lianes P, Vogelzang NJ. Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural mesothelioma. Ann Oncol. 2005 Jun;16(6):923-7. Epub 2005 Apr 11. link to original article PubMed

MVP

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MVP: Mitomycin, Vinblastine, Platinol (Cisplatin)

Regimen

Study	Evidence	Comparator
Muers et al. (MS01)	Phase III	Active symptom control Vinorelbine

Not considered a standard of care, included because it was a comparator arm.

References

Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CM, Lowry E, Nicholson AG, O'Brien M, Peake M, Rudd R, Snee M, Steele J, Girling DJ, Nankivell M, Pugh C, Parmar MK; MS01 Trial Management Group. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet. 2008 May 17;371(9625):1685-94. link to PMC article PubMed

Pemetrexed (Alimta)

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Regimen

Study	Evidence
Taylor et al. 2008	Phase II

Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes on day 1

Supportive medications:

Folic acid 350-600 mcg PO daily, starting 1-2 weeks before pemetrexed, to continue throughout therapy and at least 3 weeks after the last dose of Pemetrexed (Alimta)
Cyanocobalamin (Vitamin B12) 1000 mcg IM once 1-2 weeks before Pemetrexed (Alimta), then 1000 mcg to be given every 9 weeks thereafter while continuing on pemetrexed therapy
Dexamethasone (Decadron) 4 mg PO BID the day before, the day of, and day after Pemetrexed (Alimta)

21-day cycles

References

Taylor P, Castagneto B, Dark G, Marangolo M, Scagliotti GV, van Klaveren RJ, Labianca R, Serke M, Schuette W, van Meerbeeck JP, Heigener D, Liu Y, Adachi S, Blatter J, von Pawel J. Single-agent pemetrexed for chemonaïve and pretreated patients with malignant pleural mesothelioma: results of an International Expanded Access Program. J Thorac Oncol. 2008 Jul;3(7):764-71. link to original article contains verified protocol PubMed

Vinorelbine (Navelbine)

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Regimen

Study	Evidence	Comparator
Muers et al. (MS01)	Phase III	Active symptom control MVP

Note: The NCCN, Malignant Pleural Mesothelioma version 2.2012, lists the Vinorelbine (Navelbine) dosage as 25-30 mg/m2. No primary reference could be found for the 25 mg/m2 dosage.

Vinorelbine (Navelbine) 30 mg/m2 IV once per week x 12 weeks, with a 2-week treatment-free gap between the 6th and 7th doses

12-week course

References

Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CM, Lowry E, Nicholson AG, O'Brien M, Peake M, Rudd R, Snee M, Steele J, Girling DJ, Nankivell M, Pugh C, Parmar MK; MS01 Trial Management Group. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet. 2008 May 17;371(9625):1685-94. link to original article contains verified protocol PubMed

Second-line therapy

Best supportive care

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Regimen

Level of Evidence: Phase III

No antineoplastic treatment; used as a comparator arm and here for reference purposes only.

References

Jassem J, Ramlau R, Santoro A, Schuette W, Chemaissani A, Hong S, Blatter J, Adachi S, Hanauske A, Manegold C. 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. 2008 Apr 1;26(10):1698-704. link to original article contains verified protocol PubMed

Gemcitabine (Gemzar)

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Note: The NCCN, Malignant Pleural Mesothelioma version 2.2012, lists Gemcitabine (Gemzar) as a second-line monotherapy treatment option, but the listed reference did not provide details about its administration. No primary reference could be found for Gemcitabine (Gemzar) monotherapy in this setting.

Pemetrexed (Alimta)

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Regimen

Level of Evidence: Phase III

Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes on day 1

21-day cycles x 8 or more cycles

Supportive medications:

Folic acid 350-1000 mcg PO daily, starting 1-2 weeks before pemetrexed, to continue throughout therapy and at least 3 weeks after the last dose of pemetrexed
Cyanocobalamin (Vitamin B12) 1000 mcg IM once 1-2 weeks before pemetrexed, then 1000 mcg to be given every 9 weeks thereafter while continuing on pemetrexed therapy
Dexamethasone (Decadron) 4 mg PO BID the day before, the day of, and day after pemetrexed

References

Jassem J, Ramlau R, Santoro A, Schuette W, Chemaissani A, Hong S, Blatter J, Adachi S, Hanauske A, Manegold C. 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. 2008 Apr 1;26(10):1698-704. link to original article contains verified protocol PubMed

Vinorelbine (Navelbine)

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Regimen

Level of Evidence: Phase II

Vinorelbine (Navelbine) 30 mg/m2 (maximum of 60 mg per dose) IV over 5 minutes on days 1, 8, 15, 22, 29, 36

42-day cycles

References

Stebbing J, Powles T, McPherson K, Shamash J, Wells P, Sheaff MT, Slater S, Rudd RM, Fennell D, Steele JP. The efficacy and safety of weekly vinorelbine in relapsed malignant pleural mesothelioma. Lung Cancer. 2009 Jan;63(1):94-7. Epub 2008 May 16. link to original article contains verified protocol PubMed

@@ Line 114: / Line 114: @@
 ## '''Update:''' Manegold C, Symanowski J, Gatzemeier U, Reck M, von Pawel J, Kortsik C, Nackaerts K, Lianes P, Vogelzang NJ. Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural mesothelioma. Ann Oncol. 2005 Jun;16(6):923-7. Epub 2005 Apr 11. [http://annonc.oxfordjournals.org/content/16/6/923.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/15824080 PubMed]
-==Cisplatin (Platinol) & Gemcitabine (Gemzar) {{#subobject:9e4c22|Regimen=1}}==
+==Cisplatin & Gemcitabine {{#subobject:9e4c22|Regimen=1}}==
 {| class="wikitable" style="float:right; margin-left: 5px;"
 |-
 |[[#toc|back to top]]
 |}
-===Regimen #1, Nowak et al. 2002 {{#subobject:15fbf7|Variant=1}}===
+===Regimen #1 {{#subobject:15fbf7|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.nature.com/bjc/journal/v87/n5/full/6600505a.html Nowak et al. 2002]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 127: / Line 131: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
-*[[Cisplatin (Platinol)]] 100 mg/m2 IV over 1 hour on day 1, given first
+*[[Cisplatin (Platinol)]] 100 mg/m2 IV over 1 hour on day 1, '''given first'''
-*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV over 30 minutes on days 1, 8, 15, given second
+*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV over 30 minutes once per day on days 1, 8, 15, '''given second'''
-'''28-day cycles x up to 6 cycles'''
+Supportive medications:
+*Minimum of 3 liters of IV hydration for [[Cisplatin (Platinol)]], with magnesium supplementation
+*[[antiemesis|5HT-3 antagonists & Dexamethasone (Decadron)]] IV once per day on days 1, 8, 15 before chemotherapy
+*[[antiemesis|5HT-3 antagonists, Dexamethasone (Decadron), and/or phenothiazines]] for antiemesis PO or by rectal suppository for 3 to 5 days after [[Cisplatin (Platinol)]]
-Supportive medications:
+'''28-day cycle x up to 6 cycles'''
-*Minimum of 3 liters of IV hydration for cisplatin, with magnesium supplementation
-*[[antiemesis|5HT-3 antagonists & Dexamethasone (Decadron)]] IV on days 1, 8, 15 before chemotherapy
-*[[antiemesis|5HT-3 antagonists, Dexamethasone (Decadron), and/or phenothiazines]] for antiemesis PO or by rectal suppository for 3-5 days after cisplatin
-===Regimen #2, van Haarst et al. 2002 {{#subobject:4dfb66|Variant=1}}===
+===Regimen #2 {{#subobject:4dfb66|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.nature.com/bjc/journal/v86/n3/full/6600118a.html van Haarst et al. 2002]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 146: / Line 156: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
-*[[Cisplatin (Platinol)]] 80 mg/m2 IV over 3 hours on day 1, given second
+*[[Cisplatin (Platinol)]] 80 mg/m2 IV over 3 hours on day 1, '''given second'''
-*[[Gemcitabine (Gemzar)]] 1250 mg/m2 IV over 30 minutes on days 1 & 8, given first
+*[[Gemcitabine (Gemzar)]] 1250 mg/m2 IV over 30 minutes once per day on days 1 & 8, '''given first'''
-'''21-day cycles x up to 6 cycles'''
+Supportive medications:
+*Minimum of 2 liters of IV hydration for [[Cisplatin (Platinol)]]
+*[[antiemesis|5HT-3 antagonists & corticosteroids]] before [[Cisplatin (Platinol)]]
-Supportive medications:
+'''21-day cycle x up to 6 cycles'''
-*Minimum of 2 liters of IV hydration for cisplatin
-*[[antiemesis|5HT-3 antagonists & corticosteroids]] before cisplatin
 ===References===

Difference between revisions of "Malignant pleural mesothelioma"

Revision as of 18:33, 6 October 2015

First-line therapy

Active symptom control

Regimen

References

Carboplatin & Pemetrexed

Regimen

References

Cisplatin (Platinol)

Regimen

References

Cisplatin & Gemcitabine

Regimen #1

Regimen #2

References

Cisplatin & Pemetrexed

Regimen

References

MVP

Regimen

References

Pemetrexed (Alimta)

Regimen

References

Vinorelbine (Navelbine)

Regimen

References

Second-line therapy

Best supportive care

Regimen

References

Gemcitabine (Gemzar)

Pemetrexed (Alimta)

Regimen

References

Vinorelbine (Navelbine)

Regimen

References

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