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Three-Drug Combo May Be New Standard-of-Care for Mesothelioma Treatment

10122459_doctor2The standard of care for people with malignant pleural mesothelioma may be changing for the first time since pemetrexed (Alimta) was approved more than a decade ago.

The 27 member cancer centers of National Comprehensive Cancer Network have amended their mesothelioma treatment guidelines to include the monoclonal antibody bevacizumab (Avastin) as part of first-line therapy for qualified mesothelioma patients.

In a recent French study that received worldwide attention, bevacizumab was found to extend mesothelioma survival by 2.7 months when combined with the standard chemotherapy combination of pemetrexed (Alimta) and cisplatinAlthough this extension may seem minimal, in a disease that is typically fatal within 4 to 18 months, it is significant.

What is Bevacizumbab?

Bevacizumab is a monoclonal antibody that inhibits angiogenesis, the formation of new blood vessels. If a mesothelioma tumor is prevented from forming new blood vessels, it cannot continue to grow.

In January, French researchers reported the encouraging results of the six-year Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS).

By randomly assigning 448 pleural mesothelioma patients to receive either standard two-drug chemotherapy with pemetrexed and cisplatin or a three-drug combination including bevacizumab, they discovered that the third drug lowered the risk of death by 23 percent.

Three months later, a Chinese team reported even better survival results in a case of advanced mesothelioma when the three-drug combination was followed by six courses of pemetrexed maintenance therapy (PMT).

Guidelines for Treatment of Mesothelioma

The NCCN Guidelines recommend surgery for most mesothelioma patients with stage I to III epithelioid mesothelioma who are healthy enough to undergo surgery.

For patients with sarcomatoid mesothelioma or those with more advanced disease who aren’t eligible for surgery, the guidelines recommend chemotherapy with pemetrexed and cisplatin and now include bevacizumab as an option, as well.

The complete version of the NCCN Guidelines for Malignant Pleural Mesothelioma can be found at NCCN.org, although the patient version of the guidelines has not yet been updated to include bevacizumab.

Although physicians are under no obligation to adhere to the NCCN Guidelines, and will base their treatment recommendations on each mesothelioma patient’s individual situation, the guidelines are designed to assist with clinical decision-making.


Ettinger, DS, “NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016”, July 2016, Journal of the National Comprehensive Cancer Network, pp. 825-836

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