Mesothelioma

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12 regimens on this page
13 variants on this page


Guidelines

ESMO

NCCN

Advanced or metastatic disease, first-line therapy

Best supportive care

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Regimen

Study Evidence Comparator Efficacy
Muers et al. 2008 (MS01) Phase III MVP Seems not superior
Vinorelbine Might have inferior OS

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 link to PMC article PubMed

Carboplatin & Pemetrexed

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Regimen

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

Chemotherapy

Supportive medications

21-day cycles

Up to 9 cycles in Castagneto et al. 2007.

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 monotherapy

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Regimen

Study Evidence Comparator Efficacy
Vogelzang et al. 2003 Phase III Cisplatin & Pemetrexed Seems to have inferior OS

Chemotherapy

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

Chemotherapy

Supportive medications

28-day cycle for up to 6 cycles

Regimen #2

Study Evidence
van Haarst et al. 2002 Phase II

Chemotherapy

Supportive medications

21-day cycle for 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 link to PMC article 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 link to PMC article PubMed

Cisplatin & Pemetrexed

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Regimen

Study Evidence Comparator Efficacy
Vogelzang et al. 2003 Phase III Cisplatin Seems to have superior OS
Zalcman et al. 2016 (MAPS) Phase III PCB Seems to have inferior OS
Grosso et al. 2017 (LUME-Meso) Randomized Phase II Cisplatin, Nintedanib, Pemetrexed Inferior PFS

Note: Vogelzang et al. 2003 did not specify the total number of cycles and some patients did receive more than 6 cycles.

Chemotherapy

Supportive medications

21-day cycle for up to 6 cycles (see note)

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. 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
  3. 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

MVP

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MVP: Mitomycin, Vinblastine, Platinol (Cisplatin)

Regimen

Study Evidence Comparator Efficacy
Muers et al. 2008 (MS01) Phase III Best supportive care Seems not superior
Vinorelbine Seems not superior

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 link to PMC article PubMed

PCB

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PCB: Pemetrexed, Cisplatin, Bevacizumab

Regimen

Study Evidence Comparator Efficacy
Zalcman et al. 2016 (MAPS) Phase III PC Seems to have superior OS

Chemotherapy

21-day cycle for up to six cycles, until progression or toxic effects

References

  1. 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 monotherapy

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Regimen

Study Evidence
Taylor et al. 2008 Phase II

Chemotherapy

Supportive medications

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 monotherapy

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Regimen

Study Evidence Comparator Efficacy
Muers et al. 2008 (MS01) Phase III Best supportive carel Might have superior OS
MVP Seems not superior

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

  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 link to PMC article PubMed

Advanced or metastatic disease, second-line therapy

Best supportive care

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Regimen

Study Evidence Comparator Efficacy
Jassem et al. 2008 Phase III Pemetrexed Seems to have inferior PFS
Maio et al. 2017 (DETERMINE) Randomized Phase IIb Tremelimumab Seems not superior

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
  2. Maio M, Scherpereel A, Calabrò L, Aerts J, Perez SC, Bearz A, Nackaerts K, Fennell DA, Kowalski D, Tsao AS, Taylor P, Grosso F, Antonia SJ, Nowak AK, Taboada M, Puglisi M, Stockman PK, Kindler HL. Tremelimumab as second-line or third-line treatment in relapsed malignant mesothelioma (DETERMINE): a multicentre, international, randomised, double-blind, placebo-controlled phase 2b trial. Lancet Oncol. 2017 Sep;18(9):1261-1273. Epub 2017 Jul 17. link to original article PubMed

Gemcitabine monotherapy

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Regimen

Study Evidence
Zauderer et al. 2014 Retrospective, <20 pts

Chemotherapy

  • Gemcitabine (Gemzar) by one of two schedules:
    • 1000 mg/m2 IV once per day on days 1 & 8 of a 21-day cycle
    • 1000 mg/m2 IV once per day on days 1, 8, 15 of a 28-day cycle

21 to 28-day cycles

References

  1. 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

Gemcitabine & Vinorelbine

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Regimen

Study Evidence
Zauderer et al. 2014 Retrospective, <20 pts

Chemotherapy

21-day cycles

References

  1. 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 Evidence Comparator Efficacy
Jassem et al. 2008 Phase III Best supportive care Seems to have superior PFS

Chemotherapy

Supportive medications

21-day cycle for 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 monotherapy

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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

  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

Patient resources

  • TreatMesothelioma.org - "a Mesothelioma Treatment Community" with education information for patients about mesothelioma and treatment