Combination chemotherapy with cisplatin

Chemotherapy is one way of mesothelioma treatments that have been shown to improve survival in randomized and controlled trials. The study, published in 2003 by Vogelzang and colleagues compared cisplatin alone with combination chemotherapy of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients not receiving chemotherapy for malignant pleural mesothelioma previously and are not candidates for more aggressive "curative" operation. This experiment is the first reported survival benefit of chemotherapy in malignant pleural mesothelioma, showed statistically significant improvement in average survival of 10 months in patients treated with cisplatin alone to 13.3 months in the combination group of patients receiving pemetrexed supplementation with folate and vitamin B12.

Vitamin supplements given to most patients in the trial and related side-effects of pemetrexed was significantly smaller in patients who received pemetrexed when they also receive a daily folate 500mcg oral and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. Objective response rate increased from 20% in the cisplatin group to 46% in the combination of pemetrexed. Some side effects such as nausea and vomiting, stomatitis, and diarrhea are more common in the combination of pemetrexed group but only affects a minority of patients and the overall combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplements, good quality of life and pulmonary function tests improved in the combination of pemetrexed. In February 2004, the United States Food and Drug Administration approved pemetrexed for the treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has demonstrated an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer available commercially for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine alone, although survival benefit has not been shown for this drug. For patients who can not be used cisplatin, carboplatin can be substituted but non-random data that have shown lower response rates and high levels of haematological toxicity for carboplatin-based combinations, although the survival rates similar to patients receiving cisplatin.

In January 2009, the U.S. FDA approved the use of conventional therapies like surgery and in combination with radiation or chemotherapy in stage I or II Mesothelioma after research conducted by a national study by Duke University concluded an increase of nearly 50 points at the level of remission.

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