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Management Options for Malignant Pleural Mesothelioma

Clinical and Cost Considerations

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Abstract

Malignant pleural mesothelioma (MPM) is a resistant form of lung cancer that is often related to prior asbestos exposure. While surgical resection and radiotherapy techniques have been refined in recent years, neither has been proven to significantly extend patient survival compared with untreated controls. Until the release of pemetrexed in 2004, even combination chemotherapy regimens often resulted in a response rate of <20%. A recent phase III trial documented a 41.3% response rate for cisplatin plus pemetrexed. In the future, new multimodality regimens featuring novel targeted therapies directed against molecular targets, such as the vascular endothelial growth factor, hold the greatest promise for improved outcomes in MPM. The standard radiographic assessment of response to MPM therapy remains a poor surrogate for clinically relevant endpoints such as median survival. Furthermore, it is not currently known whether aggressive multimodality treatment for MPM will improve survival or quality of life above and beyond symptomatic care. Ongoing clinical trials are comparing chemotherapy and surgery with supportive care in an effort to define the role of different therapies in MPM. MPM treatment is a costly public health issue; after efficacy is proven, additional studies are needed to measure the cost effectiveness of MPM treatment regimens.

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No sources of funding were used to assist in the preparation of this article. The author owns stock in sanofi-aventis, the manufacturer of oxaliplatin, but has no professional connection with this company.

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  1. Department of Medicine, Duke University Medical Center, DUMC Box 31061, Durham, North Carolina, 27701, USA

    Ranjit K. Goudar

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Goudar, R.K. Management Options for Malignant Pleural Mesothelioma. Drugs 67, 1149–1165 (2007). https://doi.org/10.2165/00003495-200767080-00005

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