From the Guidelines
The treatment for malignant mesothelioma (MM) typically involves a multimodal approach combining surgery, chemotherapy, and radiation therapy, with the standard first-line chemotherapy regimen being a combination of cisplatin and pemetrexed, as recommended by the most recent guidelines 1.
Treatment Overview
The treatment of MM is highly individualized and depends on the cancer stage, cell type, patient's overall health, and personal preferences.
- Surgical options include pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) for early-stage disease.
- Chemotherapy regimens, such as cisplatin/pemetrexed, are recommended for patients with unresectable or medically inoperable MM 1.
- Radiation therapy may be used before or after surgery to kill remaining cancer cells or to help control symptoms.
Chemotherapy Regimens
The standard first-line chemotherapy regimen is a combination of cisplatin (75 mg/m² IV) and pemetrexed (500 mg/m² IV) administered every 3 weeks for 4-6 cycles, as supported by a phase III randomized trial and FDA approval 1.
- Other recommended first-line combination chemotherapy options include pemetrexed/carboplatin and gemcitabine/cisplatin.
- Single-agent options, such as pemetrexed or vinorelbine, are recommended only for patients who cannot receive platinum-doublet therapy.
Immunotherapy
Newer treatments, such as immunotherapy drugs like pembrolizumab or nivolumab, may be recommended for patients who cannot undergo surgery or as part of a multimodal approach.
- These drugs help the immune system recognize and attack cancer cells, and have shown promise in improving survival and quality of life for patients with MM.
From the Research
Treatment Options for Malignant Mesothelioma (MM)
The treatment for malignant mesothelioma (MM) typically involves a combination of therapies, including:
- Surgery: such as extrapleural pneumonectomy (EPP) or pleurectomy/decortication 2, 3, 4
- Chemotherapy: usually consisting of a platinum-based chemotherapy, such as cisplatin, often combined with a folate antimetabolite, such as pemetrexed 2, 5
- Radiation therapy (RT): including intensity modulated radiation therapy (IMRT) 3, 6
- Immunotherapy: a possible therapeutic strategy for MM 2
Multimodality Treatment Approaches
Multimodality treatment approaches, which combine two or more of these therapies, have been shown to be more effective than single-modality treatments 2, 5, 4. However, the optimal sequence and weighting of the respective treatment modalities is unclear 4. Some studies have investigated the use of trimodality treatment approaches, including EPP, chemotherapy, and RT 3.
Prognostic Factors and Complications
Prognostic factors for overall survival (OS) in MM patients include:
- Surgical treatment 4
- Multimodality therapy 4
- Epithelioid subtype 4
- Early tumor stage 4
- Absence of arterial hypertension 4 Complications, such as respiratory failure secondary to radiation pneumonitis, can occur with multimodality therapy 6.
Ongoing Research and Future Directions
Ongoing research is focused on evaluating the effectiveness of different multimodality treatment approaches and identifying the optimal sequence and weighting of the respective treatment modalities 5, 3, 4. Future prospective analysis will be needed to demonstrate the efficacy of these approaches in the treatment of MM 6.