Mesothelioma Treatment Regimens

Share this content:
SEE BELOW THE CHART TO SEE DRUG MONOGRAPHS FOR RESPIRATORY AND THORACIC CANCERS.



Mesothelioma Treatment Regimens

Clinical Trials: The National Comprehensive Cancer Network 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 cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are provided only to supplement the latest treatment strategies.

These 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 NCCN 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.

First-line Combination 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 + cisplatin + bevacizumab (Category 1)3,a

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.

Pemetrexed + carboplatin4-6,c

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

Repeat every 21 days for a max of 9 cycles.

Pemetrexed + carboplatin + bevacizumab4-7,c

Day 1: Pemetrexed 500mg/m2 IV + carboplatin AUC 5mg·min/mL IV + bevacizumab 15mg/kg.

Repeat every 21 days for 6 cycles, followed by:

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

Gemcitabine + cisplatin8,9

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.

Pemetrexed10

Day 1: Pemetrexed 500mg/m2 IV.

Repeat every 21 days for 4 cycles.

Vinorelbine11

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

Subsequent Systemic Therapy1

Pemetrexed (if not administered as first-line) (Category 1)12,13,b

Day 1: Pemetrexed 500mg/m2 IV.

Repeat every 3 weeks for 8 cycles.

Vinorelbine14,15

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

Repeat every 6 weeks for 11 cycles.

Gemcitabine15-17

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

Repeat every 28 days for a max of 10 cycles.

Nivolumab ± ipilimumab (Category 2B)18,19

Day 1: Nivolumab 3mg/kg IV over 1 hour every 2 weeks

Day 1: Ipilimumab 1mg/kg IV over 1.5 hours every 6 weeks.

Repeat until disease progression or unacceptable toxicity.

Pembrolizumab20

Day 1: Pembrolizumab 10mg/kg IV every 2 weeks.

Repeat for 2 years or until disease progression or unacceptable toxicity.

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.

c The carboplatin/pemetrexed regimen is recommended for patients with poor performance score and/or comorbidities.

References

 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCNGuidelines®) for Malignant Pleural Mesothelioma. V2.2018. Available at: https://www.nccn.org/professionals/physician_gls/pdf/mpm.pdf. Accessed March 9, 2018.

 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. Zalcman G, Mazieres J, Margery J, et al. Bevacizumab for newly diagnoised pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled open-label, Phase 3 trial. Lancet. 2016;387: 1405-1414.

 4. 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.

 5. 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.

 6. 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.

 7. Ceresoli GL, Zucali PA, Mencoboni M, et al. Phase II study of pemetrexed and carboplatin plus bevacizumab as first-line therapy in malignant pleural mesothelioma. Br J Cancer. 2013;109:552–558.

 8. 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.

 9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. Scherpereel A, Mazieres J, Greiller L, et al. Second- or third-line nivolumab (Nivo) versus nivo plus ipilimumab (Ipi) in malignant pleural mesothelioma (MPM) patients: results of the IFCT-1501 MAPS2 randomized phase 2 trial [abstract]. J Clin Oncol. 2017;35: Abstract LBA8507.

19. Zalcman G, Mazieres J, Greiller L, et al. Second or 3rd line nivolumab (Nivo) versus nivo plus ipilimumab (ipi) in malignant pleural mesothlioma (MPM) patients: Updated results of the IFCT-1501 MAPS2 randomized phase 2 trial [abstract]. Ann Oncol. 2017;28:Abstract LBA58_PR.

20. Alley EW, Lopez J, Santoro A, et al. Clinical safety and activity of pembrolizumab in patients with malignant pleural mesothelioma (KEYNOTE-028): preliminary results from a non-randomized, open-label, phase 1b trial. Lancet Oncol. 2017; 18:623–630.

(Revised 3/2018) © 2018 by Haymarket Media, Inc.


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 eMPR

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Sign Up for Free e-newsletters



Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs