Malignant pleural mesothelioma
Jump to navigation
Jump to search
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.
Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.
19 regimens on this page
33 variants on this page
|
First-line therapy
Active symptom control
| back to top |
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
| back to top |
Regimen
| Study | Evidence |
| Ceresoli et al. 2006 | Phase II |
| Castagneto et al. 2007 | Phase II |
Chemotherapy
- Carboplatin (Paraplatin) AUC 5 IV over 30 minutes once on day 1, given second, 30 minutes after pemetrexed
- Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes once on day 1, given first
Supportive medications
- (varies depending on reference):
- Folic acid 350 to 600 mcg PO once per day, 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. 2007.
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)
| back to top |
Regimen
| Study | Evidence | Comparator |
| Vogelzang et al. 2003 | Phase III | Cisplatin & Pemetrexed |
Chemotherapy
- Cisplatin (Platinol) 75 mg/m2 IV over 2 hours once 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
- 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
| back to top |
Regimen #1
| Study | Evidence |
| Nowak et al. 2002 | Phase II |
Chemotherapy
- Cisplatin (Platinol) 100 mg/m2 IV over 1 hour once 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 for up to 6 cycles
Regimen #2
| Study | Evidence |
| van Haarst et al. 2002 | Phase II |
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV over 3 hours once 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 for 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
| back to top |
Regimen
| Study | Evidence | Comparator | Efficacy |
| Vogelzang et al. 2003 | Phase III | Cisplatin | |
| Zalcman et al. 2016 (MAPS) | Phase III | PCB | Seems to have inferior OS |
Chemotherapy
- Cisplatin (Platinol) 75 mg/m2 IV over 2 hours once on day 1, given second, 30 minutes after pemetrexed
- Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes once on day 1, given first
Supportive medications
- Folic acid 350 to 1000 mcg PO once per day, 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
- 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
- Zalcman G, Mazieres J, Margery J, Greillier L, Audigier-Valette C, Moro-Sibilot D, Molinier O, Corre R, Monnet I, Gounant V, Rivière F, Janicot H, Gervais R, Locher C, Milleron B, Tran Q, Lebitasy MP, Morin F, Creveuil C, Parienti JJ, Scherpereel A; French Cooperative Thoracic Intergroup (IFCT). Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016 Apr 2;387(10026):1405-14. Epub 2015 Dec 21. Erratum in: Lancet. 2016 Apr 2;387(10026):e24. link to original article contains protocol PubMed
MVP
| back to top |
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
PCB
| back to top |
PCB: Pemetrexed, Cisplatin, Bevacizumab
Regimen
| Study | Evidence | Comparator | Efficacy |
| Zalcman et al. 2016 (MAPS) | Phase III | PC | Seems to have superior OS |
Chemotherapy
- Pemetrexed (Alimta) 500 mg/m2 IV once on day 1
- Cisplatin (Platinol) 75 mg/m2 IV once on day 1
- Bevacizumab (Avastin) 15 mg/kg IV once on day 1
21-day cycle for up to six cycles, until progression or toxic effects
References
- Zalcman G, Mazieres J, Margery J, Greillier L, Audigier-Valette C, Moro-Sibilot D, Molinier O, Corre R, Monnet I, Gounant V, Rivière F, Janicot H, Gervais R, Locher C, Milleron B, Tran Q, Lebitasy MP, Morin F, Creveuil C, Parienti JJ, Scherpereel A; French Cooperative Thoracic Intergroup (IFCT). Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016 Apr 2;387(10026):1405-14. Epub 2015 Dec 21. Erratum in: Lancet. 2016 Apr 2;387(10026):e24. link to original article contains protocol PubMed
Pemetrexed (Alimta)
| back to top |
Regimen
| Study | Evidence |
| Taylor et al. 2008 | Phase II |
Chemotherapy
- Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes once on day 1
Supportive medications
- Folic acid 350 to 600 mcg PO once per day, starting 1 to 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 to 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
| back to top |
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 to 30 mg/m2. No primary reference could be found for the 25 mg/m2 dosage.
Chemotherapy
- 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
| back to top |
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
- 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)
| back to top |
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 the first line, where it has been generally ineffective.
References
- 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)
| back to top |
Regimen
| Study | Evidence | Comparator |
| Jassem et al. 2008 | Phase III | Best supportive care |
Chemotherapy
- Pemetrexed (Alimta) 500 mg/m2 IV over 10 minutes once on day 1
Supportive medications
- Folic acid 350 to 1000 mcg PO once per day, starting 1 to 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 to 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 for 8 or more cycles
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
| back to top |
Regimen
| Study | Evidence |
| Stebbing et al. 2008 | Phase II |
Chemotherapy
- 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
- 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
Patient resources
- TreatMesothelioma.org - "a Mesothelioma Treatment Community" with education information for patients about mesothelioma and treatment