Treatment of malignant pleural mesothelioma continues to be frustratin
g regardless of the modality employed. Numerous trials of chemotherape
utic agents have been performed, but until recently, these studies wer
e small and subject to inaccuracies of disease measurement. To our kno
wledge, no chemotherapeutic regimen has emerged as a standard of care.
A review of the literature reveals that small activity against this d
isease has been shown by the anthracyclines, platinum compounds, and a
lkylating agents, whereas higher activity has been reported with the a
ntimetabolites. The plant alkaloids have not demonstrated any activity
against mesothelioma. Dose-escalated chemotherapeutic regimens may of
fer an advantage, whereas combination chemotherapy has not shown any b
enefit over single-agent therapy. Favorable responses have been report
ed with the administration of intrapleural biological response modifie
rs. Further trials and the investigation of new agents in the treatmen
t of this disease are necessary.