title: Systemic treatment of malignant pleural mesothelioma.
abstract: Malignant pleural mesothelioma is a rare malignancy with a dismal prognosis. The clinical management of most of the patients with this disease is quite challenging, and, overall, the therapeutic strategy has not yet benefited from the recent advances in molecular biology. Randomized evidence supports the use of cisplatin in combination with pemetrexed or raltitrexed as first-line treatments. In elderly patients with comorbidities cisplatin may be replaced by carboplatin because of a lesser burden of toxicities. The role of second-line chemotherapy is unproven, although pemetrexed can be regarded as the standard option in pemetrexed-naive patients and therapeutic rechallenge with pemetrexed may be considered in selected patients with prolonged disease control after first-line therapy. Targeted therapies failed to demonstrate any substantial activity; however, immunotherapies may complement other treatment strategies. In summary, there is an unmet clinical need and innovative approaches to select new potentially active drugs are highly warranted.
authors.affiliation: Division of Medical Oncology, SS. Antonio e Biagio General Hospital, Alessandria, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Grosso
authors.forename: Giorgio Vittorio
authors.initials: GV
authors.lastname: Scagliotti
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D005971:Glutamates / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008654:Mesothelioma / Q000188:drug therapy* / Q000473:pathology; D000068437:Pemetrexed; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011799:Quinazolines / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005971:Glutamates; D011799:Quinazolines; D013876:Thiophenes; D000068437:Pemetrexed; D006147:Guanine; D016190:Carboplatin; C068874:raltitrexed; D002945:Cisplatin