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Advances in the systemic therapy of malignant pleural mesothelioma

Nature Clinical Practice Oncology volume 5, pages 136–147 (2008)Cite this article

Abstract

Malignant pleural mesothelioma is an aggressive thoracic malignancy associated with exposure to asbestos, and its incidence is anticipated to increase during the first half of this century. Chemotherapy is the mainstay of treatment, yet sufficiently robust evidence to substantiate the current standard of care has emerged only in the past 5 years. This Review summarizes the evidence supporting the clinical activity of chemotherapy, discusses the use of end points for its assessment and examines the influence of clinical and biochemical prognostic factors on the natural history of malignant pleural mesothelioma. Early-phase clinical trials of second-line and novel agents are emerging from an increased understanding of mesothelioma cell biology. Coupled with high-quality translational research, such developments have real potential to improve the outlook of patients at a time of increasing incidence.

Key Points

  • Malignant pleural mesothelioma remains a highly lethal cancer, which is increasing in incidence in several countries

  • Chemotherapy is the mainstay of treatment for the majority of patients presenting as inoperable

  • Despite the therapeutic plateau of the past 20 years, randomized trials have now confirmed that combining antifolates with platinum-based therapy confers a survival benefit

  • No standard therapy has yet been defined in the second-line setting

  • New approaches for treating this disease are arising from a better understanding of the underlying biology and are beginning to be translated into the clinical setting

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Figure 1: Objective responses from a series of 59 clinical trials.
Figure 2: Comparison of response rates for platinum-based regimens.
Figure 3: Prognostic factors as predictors of outcome.

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Acknowledgements

The authors would like to thank Dr Van Shoote for her help in editing the manuscript. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. DA Fennell is a Cancer Research UK Clinician Scientist, Consultant and Senior Lecturer in Medical Oncology at Queen's University Belfast and at the Northern Ireland Cancer Centre, Belfast, Northern Ireland, UK,

    Dean A Fennell

  2. G Gaudino is Full Professor of Molecular Biology in the DISCAFF Department at the University of Piemonte Orientale 'A. Avogadro', Novara, Italy,

    Giovanni Gaudino

  3. KJ O'Byrne is Clinical Director of the Hematology, Oncology and Palliative Care Services at St James's Hospital, Dublin, Republic of Ireland,

    Kenneth J O'Byrne

  4. L Mutti is Chief of the Department of General Medicine and Director of the Laboratory of Clinical Oncology at the Vercelli Hospital, Vercelli, Italy,

    Luciano Mutti

  5. J van Meerbeeck is Head of the Unit of Thoracic Oncology at the University Hospital Ghent, and Professor in Thoracic Oncology at Ghent University, Ghent, Belgium.,

    Jan van Meerbeeck

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  1. Dean A Fennell
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  2. Giovanni Gaudino
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Correspondence to Dean A Fennell.

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Fennell, D., Gaudino, G., O'Byrne, K. et al. Advances in the systemic therapy of malignant pleural mesothelioma. Nat Rev Clin Oncol 5, 136–147 (2008). https://doi.org/10.1038/ncponc1039

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