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Mesothelioma Standard Treatment Options II
By: Govt
Standard treatment
options:
- Symptomatic treatment to include drainage of effusions,
chest tube
pleurodesis, or thoracoscopic pleurodesis.
- Palliative surgical resection
in selected patients.
- Palliative radiation therapy.
- Single-agent chemotherapy. Partial responses have been reported with
doxorubicin, epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin,
and ifosfamide.
- Combination chemotherapy (under clinical evaluation). Information
about ongoing clinical trials is available from the NCI
Cancer.gov Website.
- Multimodality clinical trials.
- Intracavitary
therapy. Intrapleural or intraperitoneal administration
of
chemotherapeutic agents (e.g., cisplatin, mitomycin,
and cytarabine) has been
reported to produce transient
reduction in the size of tumor masses and
temporary control of effusions in small clinical studies. Additional
studies are needed to define the role of intra-cavitary therapy.
The safety and efficacy of pemetrexed, an antifolate, and
cisplatin in chemotherapy-n aive patients with malignant mesothelioma
who were not eligible for curative
surgery was demonstrated in a large phase III randomized trial. This
trial compared pemetrexed (500 mg/m2) and cisplatin (75
mg/m2 on day 1) with cisplatin alone (75 mg/m2 on day 1 intravenously every 21 days). A total of 456 patients
were enrolled: 226 patients received pemetrexed plus cisplatin and 222 patients
received cisplatin alone; 8 patients did not receive therapy.
After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxic effects. Folic acid (350-1,000 µg orally)
was given daily, beginning 1 to 3 weeks before the first chemotherapy dose and
continuing daily until 1 to 3 weeks after treatment ended. A vi
tamin B12 injection (1,000 µg intramuscularly
) was administered 1 to 3 weeks before the first chemotherapy dose and was repeated
approximately every 9 weeks until treatment ended. Dexamethasone (4 mg) or
an equivalent corticosteroid
was administered orally twice daily for skin rash prophylaxis to all patients
1 day before,
on the day of, and 1 day after each pemetrexed dose.
In an analysis
of all patients who were randomized and treated, the combination of pemetrexed
and cisplatin was associated with a statistically significant improvement
in survival compared with cisplatin alone; the median
survivals were 1
2.1 versus 9.3 months, respectively (P=.020). The hazard ratio for death of
....[MORE]
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