Malignant pleural mesothelioma

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First-line therapy

Carboplatin (Paraplatin) & Pemetrexed (Alimta)

Regimen

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

Supportive medications (varies depending on reference):

  • Folic acid 350-600 mcg PO daily, starting at least 1 week before pemetrexed, to continue throughout therapy
  • Cyanocobalamin (Vitamin B12) 1000 mcg IM once at least 1 week before pemetrexed, 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
  • No NSAIDs (nonsteroidal anti-inflammatory drugs) for 2 days (5 days for NSAIDs with longer half-lives) before or after pemetrexed

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) & Gemcitabine (Gemzar)

Regimen #1, Nowak, et al. 2002

28-day cycles x up to 6 cycles

Supportive medications:

Regimen #2, van Haarst, et al. 2002

21-day cycles x up to 6 cycles

Supportive medications:

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 (Platinol) & Pemetrexed (Alimta)

Regimen

21-day cycles

Supportive medications:

  • Folic acid 350-1000 mcg PO daily, starting 1-3 weeks before pemetrexed, to continue throughout therapy
  • Cyanocobalamin (Vitamin B12) 1000 mcg IM once 1-3 weeks before pemetrexed, 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

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
  2. 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)

Regimen

21-day cycles

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
  • 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

  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)

Regimen

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 weekly x 12 weeks, with a 2-week treatment-free gap between the 6th and 7th doses

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

Gemcitabine (Gemzar)

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)

Regimen

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

  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)

Regimen

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
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