Mesothelioma Treatment Regimens

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MESOTHELIOMA TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The mesothelioma cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These mesothelioma cancer treatment regimens are provided only to supplement the latest treatment strategies.

These Cancer Treatment Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

(Revised 9/2016)

© 2016 Haymarket Media, Inc.

First-line Chemotherapy1

Note: All recommendations are Category 2A unless otherwise indicated.

REGIMEN

DOSING

Pemetrexed + cisplatin (Category 1)2

Day 1: Pemetrexed 500mg/m2 IV day 1 followed 30 minutes later by cisplatin 75mg/m2 over 2 hours.

Repeat every 21 days up to 12 cycles.

Pemetrexed + carboplatin3-5

Day 1: Pemetrexed 500mg/m2 IV and carboplatin AUC 5mg·min/mL IV.

Repeat every 21 days for a max of 9 cycles.

Gemcitabine + cisplatin6,7

Day 1: Cisplatin 80–100mg/m2 IV over 1 hour

Days 1, 8, and 15: Gemcitabine 1000–1250mg/m2 IV over 30 minutes.

Repeat every 21-28 days for 6 cycles.

Pemetrexed8

Day 1: Pemetrexed 500mg/m2 IV.

Repeat every 21 days for 4 cycles.

Vinorelbine9

Vinorelbine 25–30mg/m2 (max 60mg) IV every week for 12 weeks.

Pemetrexed + cisplatin + bevacizumab10a

Day 1: Pemetrexed 500mg/m2 IV + cisplatin 75mg/m2 IV + bevacizumab 15mg/kg IV.

Repeat every 21 days for 6 cycles, followed by:

Maintenance bevacizumab 15mg/kg every 21 days until disease progression.

Second-line Chemotherapy1

Pemetrexed (if not administered as first-line) (Category 1)11,12b

Day 1: Pemetrexed 500mg/m2 IV.

Repeat every 3 weeks for 8 cycles.

Vinorelbine13,14

Vinorelbine 30mg/m2 (max 60mg) IV weekly.

Repeat every 6 weeks for 11 cycles.

Gemcitabine14-16

Days 1, 8, and 15: Gemcitabine 1250mg/m2 IV.

Repeat every 28 days for a max of 10 cycles.

a The combination regimen of pemetrexed + cisplatin + bevacizumab is only for unresectable disease.

b Consider rechallenge if good sustained response at the time initial chemotherapy was interrupted.

References

1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCNGuidelines®) for Malignant Pleural Mesothelioma. V3.2016. Available at: http://www.nccn.org. Accessed September 9, 2016.

2. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–2644.

3. Castagneto B, Botta M, Aitini E, et al. Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma. Ann Oncol. 2008;19:370–373.

>4. Ceresoli GL, Zucali PA, Favaretto AG, et al. Phase II study of pemetrexed plus carboplatin in malignant pleural mesothelioma. J Clin Oncol. 2006;24:1443–1448.

5. Santoro A, O'Brien ME, Stahel RA, et al. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaive patients with malignant pleural mesothelioma. J Thorac Oncol. 2008;3:756–763.

6. Nowak AK, Byrne MJ, Willianson R, et al. A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma. Br J Cancer. 2002;87:491–496.

7. Van Haarst JM, Baas J, Manegold CH, et al. Multicentre phase II study of gemcitabine and cisplatin in malignant pleural mesothelioma. Br J Cancer. 2002;86:342–345.

8. Taylor P, Castagneto B, Dark G, et al. Single-agent pemetrexed for chemonaive and pretreated patients with malignant pleural mesothelioma: results of an International Expanded Access Program. J Thorac Oncol. 2008;3:764–771.

9. Muers MF, Stephens RJ, Fisher P, et al. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet. 2008;371:1685–1694.

10. Zalcman G, Mazieres J, Margery J, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2015;387 (10026):1405–1414.

11. Jassem J, Ramlau R, Santoro A, et al. Phase III trial of pemetrexed plus best supportive care compared with best supportive care in previously treated patients with advanced malignant pleural mesothelioma. J Clin Oncol. 2008;26: 1698–1704.

12. Zucal PA, Simonelli M, Michetti G, et al. Second-line chemotherapy in malignant pleural mesothelioma: results of a retrospective multicenter survey. Lung Cancer. 2012;75: 360–367.

13. Stebbing J, Powles T, McPherson K, et al. The efficacy and safety of weekly vinorelbine in relapsed malignant pleural mesothelioma. Lung Cancer. 2009;63:94–97.

14. Zauderer MG, Kass SL, Woo K, et al. Vinorelbine and gemcitabine as second- or third-line therapy for malignant pleural mesothelioma. Lung Cancer. 2014;84:271–274.

15. Manegold C, Symanowski J, Gatzemeier U, et al. Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural mesothelioma. Ann Oncol. 2005; 16:923–927.

16. van Meerbeeck JP, Baas P, Debruyne C, et al. A phase II study of gemcitabine in patients with malignant pleural mesothelioma. European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group. Cancer. 1999;85: 2577–2582.


Lung Cancer Drug Monographs

Respiratory And Thoracic Cancers

ABRAXANE ALECENSA ALIMTA
AVASTIN BLEOMYCIN CYRAMZA
DOXORUBICIN HCL DOXORUBICIN HCL SOLUTION ETOPOPHOS
ETOPOSIDE CAPSULES GEMZAR GILOTRIF
HYCAMTIN HYCAMTIN CAPSULES IRESSA
KEYTRUDA METHOTREXATE FOR INJECTION METHOTREXATE INJECTION
MUSTARGEN NAVELBINE OPDIVO
PHOTOFRIN PORTRAZZA TAGRISSO
TARCEVA TAXOL TAXOTERE
TECENTRIQ TOPOSAR TREXALL
XALKORI ZYKADIA

Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.

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