Chemotherapy of Malignant Pleural Mesothelioma: Where Are We Now and Where Are We Going?

REVIEW ARTICLE


Gunnar Hillerdal

Affiliation: Department of Lung Medicine, Karolinska University Hospital, Stockholm, Sweden

ABSTRACT

The incidence of malignant pleural mesothelioma is increasing in most industrialized countries and even more so (though from low numbers) in developing countries. The prognosis is poor, but the median survival time has improved with modern chemotherapy, and some patients can live many years in good shape. The combination of pemetrexed and a platin compound is now the standard treatment all over the world with many studies confirming its efficiency. Unfortunately, there are no other drugs or combinations of drugs that have been compared to the standard treatment. Studies on such combinations are usually small, and even if they seem to have given positive results this could be due to the selection of patients. However, lacking alternatives they can be tried as second-line or when pemetrexed is contraindicated. These drugs include Vinorelbine, liposomized Doxorubicin, Gemcitabine, and others in various combinations. It is not possible to directly compare different studies, because the selection of patients varies too much. Many second-line studies are on-going and should be encouraged, and hopefully new active drugs can be found this way. Biological therapies have so far been a disappointment with this tumor, and in vitro effects can rarely be verified in clinical studies. Exceptions are a few promising studies with histone deacetylase inhibitors that are on-going. With the present very active research, more effective treatment options of malignant mesothelioma are likely in the future.

Keywords: malignant pleural mesothelioma, chemotherapy, review

Correspondence: Gunnar Hillerdal, Department of Lung Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden. Tel: +46-8-5177000; Fax: +46-8-332998; e-mail: gunnar.hillerdal@karolinska.se