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Chemotherapy May be Underutilized for Mesothelioma

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Doctors from the Asbestos Diseases Research Institute and Sydney Medical School reached their conclusions by comparing data on mesothelioma patients and their tumor characteristics with evidence-based mesothelioma treatment guidelines. They used special “decision analysis software” to calculate what they say is the optimal utilization rate for chemotherapy in mesothelioma.

“Chemotherapy is recommended at least once during the disease trajectory in 65% of malignant pleural mesothelioma patients,” writes author Stephen Chuan-Hao Kao. According to Dr. Kao and his colleagues, that optimal rate is relatively close to what is being done for mesothelioma patients in Canada where 61% of patients got chemotherapy between 2003 and 2005 and in Australia where the rate was 54% between 2007 and 2009.

Unfortunately, the Australian study indicates that mesothelioma patients in other countries, such as the Netherlands, may be being shortchanged. The rate of mesothelioma patients receiving chemotherapy in that country was just 36% between 2005 and 2006. Overall, they found a reported chemotherapy utilization range from 18% to 61%. While the research team does not suggest a reason for this kind of disparity, they do conclude that the underutilization of chemotherapy is “likely multifactorial”.

There is no cure for pleural mesothelioma, an aggressive cancer of the pleural membrane around the lungs that is caused almost exclusively by asbestos exposure. Chemotherapy – usually with a combination of pemetrexed (Alimta) and a platinum drug like cisplatin – is typically the first line of defense. In addition to chemotherapy, some mesothelioma patients also undergo surgery and/or radiotherapy. Up-and-coming treatments like immunotherapy are the subject of intense research and are likely to play an increasingly important role in mesothelioma treatment in the next decade.


Kao, SC et al, “Estimation of an optimal chemotherapy utilization rate of malignant pleural mesothelioma: An evidence-based benchmark for cancer care”, November 10, 2014, Asia-Pacific Journal of Clinical Oncology, November 10, 2014, Epub ahead of Print

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