Randomized Trials of Systemic Medically-treated Malignant Mesothelioma

Abstract. Malignant pleural mesothelioma (MPM) is a rare but aggressive malignancy mainly localized to the pleura. Malignant mesothelioma grows highly invasive into surrounding tissue and has a low tendency to metastasize. The median overall survival (OS) of locally advanced or metastatic disease without treatment is 4-13 months but, during recent years, improvement in survival has been achieved since treatment for patients with mesothelioma has improved with better palliative care, systemic medical treatment, surgery and improved diagnostics methods. The present review aims at describing available data from randomized trials considering systemic medical treatment for this patient category. Malignant pleural mesothelioma (MPM) is a rare malignancy mainly localized to the pleura. It is an aggressive tumor with poor prognosis. Malignant mesothelioma grows highly invasive into surrounding tissue although it has a low tendency to metastasize. The median overall survival (OS) of locally advanced or metastatic disease without treatment is 4- 13 months (1, 2). Multimodality treatment, including chemotherapy, surgery and radiation therapy, is an option only for a small subset of patients and systemic treatment is the main therapeutic option for most patients. In recent years, prognosis for patients with mesothelioma has improved with better palliative care, systemic medical treatment, surgery and improved diagnostics methods. The present review aims at describing available randomized trials considering systemic medical treatment for this patient category. Materials and Methods We searched for randomized studies between different systemic medical treatments or between systemic medical treatments and best supportive care (BSC). We excluded studies concerning surgery and/or radiotherapy. We also excluded all non-randomized studies not written in English and studies where the majority of the patients did not suffer from mesothelioma. Studies were identified through a systematic search of Medline and www.clinicaltrials.gov until October 2014. In addition, all guidelines and review articles published since 2006 were systematically searched in their references for further studies.