Malignant pleural mesothelioma
Page editor | Section editor | ||
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Teja Ganta, MD Icahn School of Medicine at Mount Sinai New York, NY ![]() |
Travis Osterman, DO, MS, FAMIA Vanderbilt University Nashville, TN ![]() |
19 regimens on this page
33 variants on this page
|
Guidelines
ASCO
- 2018: Kindler et al. Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline PubMed
ESMO
- 2015: Baas et al. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. PubMed
NCCN
Advanced or metastatic disease, first-line therapy
Carboplatin & Pemetrexed
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Regimen variant #1, limited duration
Study | Evidence |
---|---|
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 IM once every 9 weeks
- Dexamethasone (Decadron) 4 mg PO twice per day 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 cycle for up to 9 cycles
Regimen variant #2, indefinite
Study | Evidence |
---|---|
Ceresoli et al. 2006 | 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 IM once every 9 weeks
- Dexamethasone (Decadron) 4 mg PO twice per day 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
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 monotherapy
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Regimen variant #1, 75 mg/m2
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Vogelzang et al. 2003 (JMCH) | 1999-2001 | Phase III (C) | Cisplatin & Pemetrexed | Seems to have inferior OS |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Cisplatin (Platinol) 75 mg/m2 IV over 2 hours once on day 1
21-day cycles
Regimen variant #2, 80 mg/m2
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
van Meerbeeck et al. 2005 (EORTC 08983/NCIC CTG BR.17) | 2000-2003 | Phase III (C) | Cisplatin & Raltitrexed | Seems to have inferior OS |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV over 1 to 2 hours once on day 1
21-day cycles
References
- JMCH: 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
- EORTC 08983/NCIC CTG BR.17: van Meerbeeck JP, Gaafar R, Manegold C, Van Klaveren RJ, Van Marck EA, Vincent M, Legrand C, Bottomley A, Debruyne C, Giaccone G; EORTC Lung Cancer Group; National Cancer Institute of Canada Clinical Trials Group. Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol. 2005 Oct 1;23(28):6881-9. link to original article contains verified protocol PubMed
Cisplatin & Gemcitabine
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Regimen variant #1, 100/1000
Study | Evidence |
---|---|
Nowak et al. 2002 | Phase II |
Chemotherapy
- Cisplatin (Platinol) 100 mg/m2 IV over 60 minutes 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
- 5-HT3 antagonists & Dexamethasone (Decadron) IV once per day on days 1, 8, 15, prior to chemotherapy
- 5-HT3 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 variant #2, 80/1250
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)
- 5-HT3 antagonists before Cisplatin (Platinol)
- 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 link to PMC article 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 link to PMC article PubMed
Cisplatin & Pemetrexed
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Regimen
FDA-recommended dose |
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Vogelzang et al. 2003 (JMCH) | 1999-2001 | Phase III (E-RT-esc) | Cisplatin | Seems to have superior OS |
Zalcman et al. 2016 (MAPS) | 2008-2014 | Phase III (C) | PCB | Seems to have inferior OS |
Grosso et al. 2017 (LUME-Meso) | 2013-2014 | Phase II/III (C) | Cisplatin, Nintedanib, Pemetrexed | Did not meet primary endpoint of PFS (*) |
Note: JMCH did not specify the total number of cycles and some patients did receive more than 6 cycles. Reported efficacy for LUME-Meso is based on the 2019 update.
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 IM once every 9 weeks
- Dexamethasone (Decadron) (dose not specified by reference) the day before, the day of, and day after Pemetrexed (Alimta)
21-day cycle for up to 6 cycles (see note)
References
- JMCH: 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
- MAPS: 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; 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
- LUME-Meso: Grosso F, Steele N, Novello S, Nowak AK, Popat S, Greillier L, John T, Leighl NB, Reck M, Taylor P, Planchard D, Sørensen JB, Socinski MA, von Wangenheim U, Loembé AB, Barrueco J, Morsli N, Scagliotti G. Nintedanib plus pemetrexed/cisplatin in patients with malignant pleural mesothelioma: Phase II results from the randomized, placebo-controlled LUME-Meso trial. J Clin Oncol. 2017 Nov 1;35(31):3591-3600. Epub 2017 Sep 11. link to original article contains verified protocol PubMed
- Update: Scagliotti GV, Gaafar R, Nowak AK, Nakano T, van Meerbeeck J, Popat S, Vogelzang NJ, Grosso F, Aboelhassan R, Jakopovic M, Ceresoli GL, Taylor P, Orlandi F, Fennell DA, Novello S, Scherpereel A, Kuribayashi K, Cedres S, Sørensen JB, Pavlakis N, Reck M, Velema D, von Wangenheim U, Kim M, Barrueco J, Tsao AS. Nintedanib in combination with pemetrexed and cisplatin for chemotherapy-naive patients with advanced malignant pleural mesothelioma (LUME-Meso): a double-blind, randomised, placebo-controlled phase 3 trial. Lancet Respir Med. 2019 Jul;7(7):569-580. Epub 2019 May 15. link to original article PubMed
Cisplatin & Raltitrexed
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Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
van Meerbeeck et al. 2005 (EORTC 08983/NCIC CTG BR.17) | 2000-2003 | Phase III (E-esc) | Cisplatin | Seems to have superior OS |
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV over 1 to 2 hours once on day 1, given second
- Raltitrexed (Tomudex) 3 mg/m2 IV over 15 minutes once on day 1, given first
21-day cycles
References
- EORTC 08983/NCIC CTG BR.17: van Meerbeeck JP, Gaafar R, Manegold C, Van Klaveren RJ, Van Marck EA, Vincent M, Legrand C, Bottomley A, Debruyne C, Giaccone G; EORTC Lung Cancer Group; National Cancer Institute of Canada Clinical Trials Group. Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol. 2005 Oct 1;23(28):6881-9. link to original article contains verified protocol PubMed
Cisplatin, Pemetrexed, Bevacizumab
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PCB: Pemetrexed, Cisplatin, Bevacizumab
Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Zalcman et al. 2016 (MAPS) | 2008-2014 | Phase III (E-esc) | PC | Seems to have superior OS |
Chemotherapy
- Cisplatin (Platinol) 75 mg/m2 IV once on day 1
- Pemetrexed (Alimta) 500 mg/m2 IV once on day 1
Targeted therapy
- Bevacizumab (Avastin) 15 mg/kg IV once on day 1
21-day cycle for up to 6 cycles
References
- MAPS: 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; 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
Cisplatin, Pemetrexed, TTFields
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Regimen
Study | Evidence |
---|---|
Ceresoli et al. 2019 (STELLAR) | Phase II |
Chemotherapy
- Cisplatin (Platinol) 75 mg/m2 IV once on day 1
- Pemetrexed (Alimta) 500 mg/m2 IV once on day 1
21-day cycle for up to 6 cycles
Tumor treating fields
References
- STELLAR: Ceresoli GL, Aerts JG, Dziadziuszko R, Ramlau R, Cedres S, van Meerbeeck JP, Mencoboni M, Planchard D, Chella A, Crinò L, Krzakowski M, Rüssel J, Maconi A, Gianoncelli L, Grosso F. Tumour Treating Fields in combination with pemetrexed and cisplatin or carboplatin as first-line treatment for unresectable malignant pleural mesothelioma (STELLAR): a multicentre, single-arm phase 2 trial. Lancet Oncol. 2019 Oct 15. [Epub ahead of print] link to original article PubMed
Ipilimumab & Nivolumab
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Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Baas et al. 2020 (CheckMate 743) | 2016-2018 | Phase III | Platinum doublet | Superior OS |
Immunotherapy
- Ipilimumab (Yervoy) 1 mg/kg IV once on day 1
- Nivolumab (Opdivo) 3 mg/kg IV once per day on days 1, 15, 29
42-day cycles
References
- Checkmate 743: Baas P, Scherpereel A, Nowak AK, et al: First-line nivolumab + ipilimumab vs chemotherapy in unresectable malignant pleural mesothelioma: CheckMate 743. 2020 World Conference on Lung Cancer. Presidential Symposium. Abstract 3 link to original abstract
Pemetrexed monotherapy
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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 IM once every 9 weeks
- Dexamethasone (Decadron) 4 mg PO twice per day 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 monotherapy
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Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Muers et al. 2008 (MS01) | 2001-2006 | Phase III (E-esc) | 1. Best supportive care | Might have superior OS |
2. MVP | Did not meet primary endpoint of OS |
Note: Some guidelines list the dosage as 25 to 30 mg/m2. No primary reference could be found for the 25 mg/m2 dosage. Note also that it is not clear from the reference whether 11 or 12 doses were given.
Chemotherapy
- Vinorelbine (Navelbine) 30 mg/m2 IV once per day on days 1, 8, 15, 22, 29, 36
7-week cycle for 2 cycles
References
- MS01: 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 link to PMC article PubMed
Advanced or metastatic disease, subsequent lines of therapy
Doxorubicin monotherapy
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Regimen variant #1, 60 mg/m2
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Doxorubicin & NGR-hTNF | Did not meet primary endpoint of OS |
Note: this is the lower bound of dosing used in NGR015. To our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Doxorubicin (Adriamycin) 60 mg/m2 IV once on day 1
21-day cycle for up to 6 cycles
Regimen variant #2, 75 mg/m2
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Doxorubicin & NGR-hTNF | Did not meet primary endpoint of OS |
Note: this is the upper bound of dosing used in NGR015. To our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Doxorubicin (Adriamycin) 75 mg/m2 IV once on day 1
21-day cycle for up to 6 cycles
References
- NGR015: Gregorc V, Gaafar RM, Favaretto A, Grossi F, Jassem J, Polychronis A, Bidoli P, Tiseo M, Shah R, Taylor P, Novello S, Muzio A, Bearz A, Greillier L, Fontana F, Salini G, Lambiase A, O'Brien M. NGR-hTNF in combination with best investigator choice in previously treated malignant pleural mesothelioma (NGR015): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Oncol. 2018 Jun;19(6):799-811. Epub 2018 May 9. link to original article contains protocol PubMed NCT01098266
Gemcitabine monotherapy
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Regimen variant #1, 1000 mg/m2, 2 out of 3 weeks
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Gemcitabine & NGR-hTNF | Did not meet primary endpoint of OS |
Note: this is the lower bound of dosing used in NGR015. To our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV once per day on days 1 & 8
21-day cycle for up to 6 cycles
Regimen variant #2, 1000 mg/m2, 3 out of 4 weeks
Study | Evidence |
---|---|
Zauderer et al. 2014meso | Retrospective, <20 pts |
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV once per day on days 1, 8, 15
28-day cycles
Regimen variant #3, 1250 mg/m2, 2 out of 3 weeks
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Gemcitabine & NGR-hTNF | Did not meet primary endpoint of OS |
Note: this is the upper bound of dosing used in NGR015. To our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Gemcitabine (Gemzar) 1250 mg/m2 IV once per day on days 1 & 8
21-day cycle for up to 6 cycles
References
- Retrospective: Zauderer MG, Kass SL, Woo K, Sima CS, Ginsberg MS, Krug LM. Vinorelbine and gemcitabine as second- or third-line therapy for malignant pleural mesothelioma. Lung Cancer. 2014 Jun;84(3):271-4. Epub 2014 Mar 14. link to original article contains protocol link to PMC article PubMed
- NGR015: Gregorc V, Gaafar RM, Favaretto A, Grossi F, Jassem J, Polychronis A, Bidoli P, Tiseo M, Shah R, Taylor P, Novello S, Muzio A, Bearz A, Greillier L, Fontana F, Salini G, Lambiase A, O'Brien M. NGR-hTNF in combination with best investigator choice in previously treated malignant pleural mesothelioma (NGR015): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Oncol. 2018 Jun;19(6):799-811. Epub 2018 May 9. link to original article contains protocol PubMed NCT01098266
Gemcitabine & Vinorelbine
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Regimen
Study | Evidence |
---|---|
Zauderer et al. 2014meso | Retrospective, <20 pts |
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV once per day on days 1 & 8
- Vinorelbine (Navelbine) 25 mg/m2 IV once per day on days 1 & 8
21-day cycles
References
- Retrospective: Zauderer MG, Kass SL, Woo K, Sima CS, Ginsberg MS, Krug LM. Vinorelbine and gemcitabine as second- or third-line therapy for malignant pleural mesothelioma. Lung Cancer. 2014 Jun;84(3):271-4. Epub 2014 Mar 14. contains protocol link to PMC article PubMed
Pemetrexed monotherapy
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Regimen
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Jassem et al. 2008 | 2001-2004 | Phase III (E-esc) | Best supportive care | Seems to have superior PFS |
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 IM once every 9 weeks
- Dexamethasone (Decadron) 4 mg PO twice per day 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
Vinorelbine monotherapy
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Regimen variant #1, 25 mg/m2 IV, 2 weeks out of 3
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Vinorelbine & NGR-hTNF | Did not meet primary endpoint of OS |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Vinorelbine (Navelbine) 25 mg/m2 IV once per day on days 1 & 8
21-day cycle for up to 6 cycles
Regimen variant #2, 25 mg/m2 IV, weekly
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Vinorelbine & NGR-hTNF | Did not meet primary endpoint of OS |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Vinorelbine (Navelbine) 25 mg/m2 IV once per day on days 1, 8, 15
21-day cycle for 4 cycles
Regimen variant #3, 30 mg/m2
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
Regimen variant #4, 60 mg/m2 PO, 2 weeks out of 3
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Vinorelbine & NGR-hTNF | Did not meet primary endpoint of OS |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Vinorelbine (Navelbine) 60 mg/m2 PO once per day on days 1 & 8
21-day cycle for up to 6 cycles
Regimen variant #5, 60 mg/m2 PO, weekly
Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gregorc et al. 2018 (NGR015) | 2010-2013 | Phase III (C) | Vinorelbine & NGR-hTNF | Did not meet primary endpoint of OS |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Vinorelbine (Navelbine) 60 mg/m2 PO once per day on days 1, 8, 15
21-day cycle for 4 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
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