Malignant pleural mesothelioma

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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

1. 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

1. 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
2. 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

1. 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

1. 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
2. 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
Zalcman et al. 2015 (IFCT-GFPC-0701 MAPS)	Phase III	Cisplatin, Pemetrexed, Bevacizumab

• 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

1. 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
2. Abstract: Gerard Zalcman, Julien Mazières, Jacques Margery, Laurent Greillier, Clarisse Audigier-Valette, Denis Moro-Sibilot, Oliver Molinier, Romain Corre, Isabelle Monnet, Valérie Gounant, Henri Janicot, Radj Gervais, Chrystele Locher, Bernard Milleron, Quan Tran, Marie Paule Lebitasy, Franck Morin, Christian Creveuil, Jean-Jacques Parienti, Arnaud Scherpereel, French Cooperative Thoracic Intergroup (IFCT). Bevacizumab 15mg/kg plus cisplatin-pemetrexed (CP) triplet versus CP doublet in Malignant Pleural Mesothelioma (MPM): Results of the IFCT-GFPC-0701 MAPS randomized phase 3 trial. J Clin Oncol 33, 2015 (suppl; abstr 7500) link to abstract

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

1. 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

1. 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

1. 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

Study	Evidence	Comparator
Jassem et al. 2008	Phase III	Pemetrexed

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

References

1. 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 dosing of Gemcitabine (Gemzar) monotherapy in this setting, although its use is described in Manegold et al. 2005.

References

1. 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

Pemetrexed (Alimta)

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Regimen

Study	Evidence	Comparator
Jassem et al. 2008	Phase III	Best supportive care

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

Supportive medications:

• Folic acid 350-1000 mcg PO daily, starting 1-2 weeks before Pemetrexed (Alimta), 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 (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 cycle x 8 or more cycles

References

1. 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

Study	Evidence
Stebbing et al. 2008	Phase II

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

42-day cycles

References

1. 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