Treatment for Mesothelioma
My 67-year-old husband was recently diagnosed with Malignant Pleural Mesothelioma. He was and remains asymptomatic of any mesothelioma-associated problems. He underwent pleurectomy/decortication with 2 small malignant plaques, one of which included one mediastinal lymph node positive for mesothelioma metastasis. The next recommendation is chemotherapy. We have looked into clinical trials for chemotherapy. My question is: What is the standard combination chemotherapy, what is the response rate, or what clinical trials may be appropriate? Also, are there any newer therapies, i.e.: biological, gene, photodynamic, etc. that may give a better response rate and survival time in the treatment of mesothelioma? Thank you so much.
Anil Vachani, MD, Pulmonologist at Penn Medicine, responds:
The standard first-line chemotherapy for mesothelioma is a combination regimen of Alimta (pemetrexed) and either cisplatin or carboplatin. A recent study has demonstrated approximately a 30% improvement in survival time with this regimen when compared to single agent chemotherapy (however, this study was done in patients who were not eligible for any surgery). This chemotherapy combination is also the most common regimen given following pleurectomy/decortications that your husband has undergone. There are also several ongoing clinical trials for patients with mesothelioma. In a Phase I gene therapy trial that delivers a gene to the pleural space, the gene is designed to activate the patient's immune system against the tumor. However, your husband may not be eligible for this trial given that he has had a pleurectomy.
There is also a Phase III trial of an oral chemotherapy agent in patients who have already received Alimta and cisplatin/carboplatin. When used, photodynamic therapy is typically delivered at the time of surgery and would likely not be an option for your husband at this time. Other clinical trials for mesothelioma can be found using OncoLink's clinical trials matching service, which lists University of Pennsylvania trials, as well as trials across the United States.