Current Systemic Management of Pleural Malignant Mesothelioma


Malignant mesothelioma remains an uncommon malignancy of the pleura. Standard systemic therapy involves the use of pemetrexed and cisplatin. Recent results of a phase III, randomized clinical trial presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in June 2015 support the addition of bevacizumab to this regimen. The study showed that the addition of bevacizumab improved progression-free survival and overall survival in those without contraindications to vascular endothelial growth factor inhibitor therapy. Second-line therapies yield modest efficacy, but commonly used agents include vinorelbine and gemcitabine, largely based on small phase II trials prior to the first-line use of pemetrexed. Efforts are ongoing to improve systemic options in all lines of therapy. Based on the success in other disease, promising new drugs are being explored that target key aberrant pathways in mesothelioma. Additionally, the advent of immunotherapies has led to some exciting results in mesothelioma….


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