CHEMOTHERAPY IN MALIGNANT PLEURAL MESOTHELIOMA - A REVIEW

Purpose and Design: We reviewed the published literature malignant ple ural mesothelioma, including phase II trials of the newer antifolates and plant derivatives, as well as older single-agent and combination c hemotherapy trials, We excluded trials with less than 15 patients, alt hough we have mentioned smaller trials in the text to make a specific point, as well as ones that show promise, We have also included confid ence intervals when cited in the original reports, or calculated them when absent. Results: No drugs have consistently induced a response gr eater than 20%. Higher response rates have been reported with detorubi cin, high-dose methotrexate, and edatrexate at 26%, 37%, and 25%, resp ectively, but these have yet to be confirmed, Agents that produce resp onse rates in 10% to 20% of patients include doxorubicin, epirubicin, mitomycin, cyclophosphamide, ifosfamide, cisplatin, and carboplatin, C ombination chemotherapy trials do not demonstrate a consistently great er response rate than single-agent trials, However, the combination of doxorubicin, cisplatin, bleomycin, and mitomycin demonstrated a respo nse rate of 44% (95% confidence interval, 27% to 63%), but this remain s unconfirmed. Intrapleural therapy using interferon gamma, particular ly for small-volume disease, shows promise. Conclusion: The successful treatment of unresectable pleural mesothelioma awaits the discovery o f active drugs. Recent trials of high-dose methotrexate and other anti folates are encouraging, Newer agents, including suramin, should be ev aluated in phase II trials. Off-protocol combination therapy cannot be recommended over single-agent therapy, but studies that use combinati ons of the newer agents should be conducted. (C) 1996 by American Soci ety of Clinical Oncology.