Three-Drug Combo is New Standard of Care for Pleural Mesothelioma in France

France has a new standard of care for people with unresectable malignant pleural mesothelioma.

Along with the chemotherapy drugs cisplatin and pemetrexed (Alimta), French doctors are now regularly also using bevacizumab (Avastin) to boost the effectiveness of mesothelioma chemotherapy.

The addition of Avastin to standard mesothelioma care came after the 2016 French-led mesothelioma avastin cisplatin pemetrexed study (MAPS) showed that the VEGF inhibitor improved mesothelioma survival by 23 percent.

In the US, the National Comprehensive Cancer Network guidelines have also included this three-drug combination as an option for standard first-line mesothelioma treatment since 2016.

New Review of Avastin for Mesothelioma

In a new article in the medical journal Future Oncology, doctors from Bichat-Claude Bernard Hospital in Paris reviewed the safety and efficacy of Avastin, a monoclonal anti-VEGF antibody, as an addition to standard chemotherapy for mesothelioma patients.

Although mesothelioma is rare in France, as it is in the US, nearly all cases can be directly linked to asbestos exposure, typically in an occupational setting. Unlike the US, France instituted a complete ban on the use of asbestos in 1997.

“Based on the results of the Phase III IFCT-0701 mesothelioma avastin cisplatin pemetrexed study, cisplatin-pemetrexed-bevacizumab is now the accepted standard in France,” writes author Solenn Brosseau with the department of thoracic oncology at Bichat-Claude Bernard Hospital.

Although multiple studies have confirmed the potential of Avastin in mesothelioma treatment, there are still limitations to its use. Because it has been linked to cardiac-related complications, mesothelioma patients who want to try it must be carefully-screened to avoid serious side effects.

VEGF Inhibitors in Mesothelioma Treatment

Like all tissues in the body, mesothelioma tumors need blood vessels to live and grow. VEGF is a protein that stimulates the formation of new blood vessels. Evidence suggests that it may also suppress the immune system’s ability to fight cancers like malignant mesothelioma.

Bevacizumab is one of several VEGF inhibitors now being tested for their cancer-fighting ability. A VEGF inhibitor called nintedanib (Ofev) was found to extend mesothelioma survival by a median of five months in a recent trial and has now moved into the Phase III part of a study including 450 pleural mesothelioma patients.

Sorafenib (Nexavar) and cediranib (Recentin) have also been shown to have an impact on the effectiveness of mesothelioma chemotherapy.


Brosseau, S, et al, “A review of bevacizumab in the treatment of malignant pleural mesothelioma”, September 20, 2017, Future Oncology, Epub ahead of print

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