34. Malignant Mesothelioma
34.1 General considerations
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Stage grouping |
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Stage I T1,2 N0 M0 |
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Stage II T1,2 N1 M0 |
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Stage III T1,2 N2 M0 T3 N0-2 M0 |
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Stage IV any T N3 M0 T4 any N M0 any T any N M1 |
Malignant mesothelioma is generally considered to be unresponsive to
therapy and best supportive care continues to be a standard of treatment.
Radical surgery is often not possible. Radiotherapy is palliative at best
but does not prolong survival, and only a few cytostatics produce
consistent response rates in the range of 10-20%.
Recently, results reported for multimodality approaches(cytoreductive surgery followed by sequential chemotherapy and radiotherapy) look favorable for selected patients.Randomized trials should be awaited to determine if the improvement in survival are not simply due to patient selection.
Literature:
BUTCHART, Oncologist 4(1999): 488-500
HO et al, Cancer Treat.Res.105(2001):327-337
JAKLITSCH et al,World J.Surg.25(2001):210-217
LEE et al, Curr.Opin.Pulm.Med.6(2000):267-274
ONG and VOGELZANG, J.Clin.Oncol.14(1996):1007-1017
RUFFIE et al, Br.J.Cancer 84(Suppl 2)(2001):49-50
STERNMAN et al,Chest 116(1999):504-520
34.2 Single agent chemotherapy
Agents that produce response rates in the range of 10-20% include doxorubicin,epirubicin, mitomycin, ifosfamide,cisplatin,carboplatin,vinorelbine, paclitaxel and new antifolates(gemcitabine,pemetrexed, raltitrexed ).Higher - but unconfirmed - response rates have been reported with high-dose methotrexate and edatrexate, e.g.
34.2.1 Epirubicin
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Epirubicin 110mg/mē i.v.(bolus) d1 |
To be repeated every 3 weeks
Literature:
MATTSON et al, J.Clin.Oncol.10(1992):824-828
34.2.2 Vinorelbine
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Vinorelbine 30mg/mē i.v.(5 min inj.) weekly (max 60 mg) |
One cycle of therapy consists of 6 weekly injections(outpatient
therapy)
Literature:
STEELE et al, J.Clin.Oncol.18(2000):3912-3917
34.3 Combination chemotherapy
Combination chemotherapy regimens do not demonstrate a consistently greater response rate than single agents,e.g.
34.3.1 Doxorubicin + cisplatin
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Doxorubicin 60mg/mē i.v.(bolus) d1 |
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Cisplatin 60mg/mē i.v.(1 h inf) d1 |
To be repeated every 3-4 weeks
Literature:
ARDIZZONI et al, Cancer 67(1991):2984-2987
34.3.2 Gemcitabine + cisplatin
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Gemcitabine 1000mg/mē i.v.(30 min inf) d1,8,15 |
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Cisplatin 100mg/mē i.v.( 2 h inf) d1 |
To be repeated every 4 weeks (6 cycles)
Literature:
BYRNE et al.J.Clin.Oncol.17(1999):25-30