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Predicting Mesothelioma Treatment Response

Predicting Mesothelioma Treatment Response

Certain types of biomarkers can help doctors predict the best chemotherapy treatment for patients with malignant pleural mesothelioma.

Researchers from Cairo University in Egypt looked at 91 mesothelioma patients. They tested two different chemotherapy drug combinations: pemetrexed plus cisplatin and gemcitabine plus cisplatin.

FDA Approved Treatment Options

Mesothelioma is a rare cancer caused by asbestos and standard therapies are limited. Most mesothelioma patients have chemotherapy as their first-line treatment. If they are healthy enough, they may also have surgery or radiation therapy.

Chemotherapy is a group of toxic drugs that kill cells by damaging their DNA. As of this writing, the only FDA approved chemotherapy for malignant pleural mesothelioma is a combination of pemetrexed and cisplatin.

Gemcitabine is not an FDA-approved treatment for mesothelioma, but researchers have been exploring its use as a second-line treatment.

Biomarkers Predict Individual Patient Response

The goal of this study was to find out if certain biomarkers could predict how a mesothelioma patient might respond to different chemotherapy regimens.

The researchers looked at three biomarkers: thymidylate synthase, ERCC1, and RRM1.

Patients with lower levels thymidylate synthase had better treatment outcomes with pemetrexed-based chemotherapy. On the other hand, Patients with low levels of RRM1 has better overall survival on gemcitabine plus cisplatin chemotherapy.

Patients with low levels of ERCC1 had a better response to both chemotherapy regimens with cisplatin.

The researchers recommend that ERCC1 expression should be tested in patients with malignant pleural mesothelioma before starting chemotherapy with cisplatin. They think that if the levels of ERCC1 are high, the patient might be a better candidate for immunotherapy than chemotherapy.

If a doctor wants to start chemotherapy with pemetrexed, they might want to test levels of thymidylate synthase in the patient. If the levels are high, they might not respond well to this type of treatment.

A test for RRM1 levels in a mesothelioma patient could indicate whether gemcitabine-based chemotherapy will be helpful.


Wahba NI, Khorsid O, Abo Elkasem F, Bahnassy A, Gaafer R. The Predictive Value of ERCC1, RRM1, and Thymidylate Synthase in Advanced Malignant Pleural Mesothelioma Patients Treated with Platinum-Based Chemotherapy. Asian Pac J Cancer Prev. 2023:24(1);195-205. doi: 10.31557/APJCP.2023.24.1.195. https://pubmed.ncbi.nlm.nih.gov/36708568


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