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Clinical Trial May be Best Second-Line Approach for Mesothelioma

Doctor holding x-ray filmThe best second-line treatment for mesothelioma patients who fail to respond to standard chemotherapy is probably to enroll in a clinical trial. The authors of a newly-published paper on the subject reached that conclusion after reviewing the results of 29 studies on potential second- or third-line mesothelioma treatments.

Most patients who are diagnosed with mesothelioma, an aggressive malignancy associated with asbestos exposure, will undergo chemotherapy, either as a stand-alone treatment or as part of a multimodal approach. Unfortunately, only a small percentage of mesothelioma patients treated with standard pemetrexed/cisplatin chemotherapy will show a response. Even those who respond to chemotherapy often relapse again later.

Scientists around the world are searching for new drugs and drug combinations to offer mesothelioma patients who have either failed to respond or have relapsed after standard chemotherapy. The authors of the new review of systemic therapies combed the medical literature for evidence that any of these new treatments might be viable. They found three Phase III studies, eighteen Phase II studies, and eight retrospective studies (using data on past patients) focused on second- and third-line mesothelioma therapies.

“For the Phase III studies, none have achieved an overall survival benefit; while for the Phase II studies, the majority have not achieved sufficient satisfactory outcome to justify advancement to Phase III studies,” write Omar Abdel-Rahman and Mohamed Kelany of Ain Shams University in Cairo, Egypt. Based on these findings, they conclude that the best option for most mesothelioma patients would be to enroll in an “appropriately designed clinical trial”.

If a clinical trial is not available or accessible, Drs. Abdel-Rahman and Kelany say the evidence is strongest for second line mesothelioma treatments based on the drugs gemcitabine (Gemzar) and/or vinorelbine (Navelbine). They also suggest that mesothelioma patients who responded to pemetrexed the first time around might benefit from retreatment with the same drug. The new article appears in Expert Review of Respiratory Medicine.


Abdel-Rahman, O and Kelany, M, “Systemic therapy options for malignant pleural mesothelioma beyond first time therapy: a systematic review”, September 7, 2015, Expert Review of Respiratory Medicine, Epub ahead of print

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