Advanced Malignant Mesothelioma (Stages II, III, and IV)
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Standard Treatment Options for Patients With Limited-Stage Small Cell Lung Cancer (SCLC)
Standard treatment options for patients with limited-stage SCLC include the following:
Chemotherapy and radiation therapy.
Combination chemotherapy alone.
Surgery followed by chemotherapy or chemoradiotherapy.
Prophylactic cranial irradiation.
Chemotherapy and radiation therapy
Combined-modality treatment with etoposide and cisplatin with thoracic radiation therapy (TRT) is the...
Intracavitary therapy. Intrapleural or intraperitoneal administration of chemotherapeutic agents (e.g., cisplatin, mitomycin, and cytarabine) has been reported to produce transient reduction in the size of tumor masses and temporary control of effusions in small clinical studies.[14,15,16] Additional studies are needed to define the role of intracavitary therapy.
A large randomized study from the United Kingdom (BTS-MRC-MS01) compared active symptom control (ASC) with the chemotherapy regimens of mitomycin C, vinblastine, and cisplatin (MVP) or single-agent vinorelbine. The trial was sized to detect a difference of 9 to 12 months in median survival with a total of 840 patients. As a result of slow accrual, the two chemotherapy regimens were collapsed, and the statistical plan revised. In a total of 409 patients, no significant difference in survival was detected between ASC and chemotherapy.[Level of evidence: 1iiA]
Many phase II trials of chemotherapy have been reported.[6,7,9] The safety and efficacy of pemetrexed, an antifolate, and cisplatin in chemotherapy-naive patients with malignant mesothelioma who were not eligible for curative surgery was demonstrated in a randomized phase III trial.[Level of evidence: 1iiA] This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 on day 1) with cisplatin alone (75 mg/m2 on day 1 intravenously every 21 days). With a total of 456 enrolled patients in the trial, 226 patients received pemetrexed plus cisplatin, 222 patients received cisplatin alone, and 8 patients did not receive therapy. After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxic effects. Folic acid (350-1,000 �g orally) was given daily, beginning 1 to 3 weeks before the first chemotherapy dose and continuing daily until 1 to 3 weeks after treatment ended. A vitamin B12 injection (1,000 �g intramuscularly) was administered 1 to 3 weeks before the first chemotherapy dose and was repeated approximately every 9 weeks until treatment ended. Dexamethasone (4 mg) or an equivalent corticosteroid was administered orally twice daily for skin rash prophylaxis to all patients 1 day before, on the day of, and 1 day after each pemetrexed dose.