Systemic chemotherapy in the management of malignant peritoneal mesothelioma

To review available evidence on the efficacy of chemotherapy in malignant mesothelioma of any origin.

All original research and review papers related to the role of systemic chemotherapy in the treatment of malignant mesothelioma, published from 1966 through February 2005, were identified through a MEDLINE search of the literature using the following search terms: "mesothelioma", "peritoneal", "chemotherapy", "antifolates", "cancer therapy". This search was supplemented by a manual search of the Proceedings of the Annual Meetings of the American Association for Cancer Research, American Society of Clinical Oncology, and the American Association for Cancer Research (AACR)-European Organization for Research and Treatment of Cancer (EORTC)-National Cancer Institute (NCI) Symposium on New Anticancer Drugs.

Pemetrexed in combination with cisplatin is the first treatment regimen that demonstrates a survival improvement in patients with unresectable malignant pleural mesothelioma. Data from uncontrolled studies suggest similar antineoplastic efficacy in patients with mesothelioma of peritoneal origin. Preliminary results also suggest a possible survival advantage for a combination of cisplatin and raltitrexed as compared to cisplatin alone. Other cytotoxic agents that have shown to be active in this setting include vinorelbine and gemcitabine, either alone or combined with platinum compounds.

The pemetrexed-cisplatin combination has become the new standard of care for patients with unresectable malignant mesothelioma. Future strategies shall incorporate these novel agents into multimodality approaches at earlier stages of the disease. Given the low incidence of this disease, encouraging physicians to refer these patients to specialized centers and patients to participate in clinical trials is of utmost importance.