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Which Mesothelioma Patients will Benefit from Second-Line Chemotherapy

second-line chemotherapyJapanese oncologists say they have found a way to help predict which peritoneal mesothelioma patients are most likely to get results from second-line chemotherapy.

First-line therapy is the mesothelioma treatment that doctors try first. Usually, that is chemotherapy. If that does not work or stops working, they may move on to another option. Second-line chemotherapy is one of those options. 

Doctors at National Cancer Center Hospital in Tokyo evaluated mesothelioma cases. These were patients at their institution between 2007 and 2019. They found that patients who have more rounds of first-line chemotherapy are most likely to respond to second-line chemotherapy. 

Drug Treatment for Malignant Mesothelioma

Peritoneal mesothelioma is a cancer on the lining that surrounds the abdominal organs. It usually occurs in people who were exposed to asbestos earlier in life. The greater the exposure, the higher the chance a person will develop mesothelioma. But even small amounts of asbestos can trigger mesothelioma in certain people. 

The main treatment for peritoneal mesothelioma is chemotherapy. Alimta (pemetrexed) is the primary chemotherapy drug for mesothelioma. It is usually combined with a platinum drug like cisplatin or carboplatin.

There is no approved second-line treatment for mesothelioma. But second-line chemotherapy is one option if cancer comes back after first line treatment. It helps some patients and does not help others. The Japanese team wondered if there was a way to predict which patients were likely to have the best results. 

Evaluating Second-Line Chemotherapy

The team identified 54 mesothelioma patients who received first-line chemotherapy and 26 who had second-line chemotherapy. Some of the patients also had additional drugs like gemcitabine, nivolumab, or taxane that may help chemotherapy work better. 

Median overall survival for mesothelioma patients who had second-line chemotherapy was 16.9 months. It took a median of 3.2 months for their cancer to start growing again after treatment. The patients who lived the longest after second-line treatment were those who had six or more rounds of first-line chemotherapy.

“Second-line chemotherapy may be an option for refractory malignant peritoneal mesothelioma, especially in patients who have completed 6 cycles of platinum plus pemetrexed as first-line chemotherapy,” concludes researcher Rui Kitadai.

About 2,500 Americans receive a mesothelioma diagnosis every year. First-line chemotherapy is only marginally effective for most people. That is why it is especially important for mesothelioma patients to have promising second-line options. 


Kitadai, R, et al, “Efficacy of second-line treatment and prognostic factors in patients with advanced malignant peritoneal mesothelioma: a retrospective study”, March 21, BMC Cancer, https://bmccancer.biomedcentral.com/articles/10.1186/s12885-021-08025-x

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