Systemic therapy options for malignant pleural mesothelioma beyond first-line therapy: a systematic review

Abstract

The aim of this systematic review is to assess the evidence for the available 2nd/3rd line systemic therapies for malignant pleural mesothelioma (MPM). Eligible studies were obtained through appropriate databases and meetings abstracts search. A total of 29 studies were considered eligible for this review and it includes three Phase III studies, eighteen phase II studies and eight retrospective studies. For the Phase III studies, none have achieved an overall survival benefit; while for the Phase II studies, the majority have not achieved sufficient satisfactory outcome to justify advancement to Phase III studies. We believe that the best salvage treatment for MPM would be inclusion into appropriately designed clinical trials. In the absence of a clinical trial, gemcitabine and/or vinorelbine-based regimens could be considered. Moreover, pemetrexed re-challenge can be considered in selected pemetrexed-sensitive patients.

Keywords:

• mesothelioma
• salvage treatment
• second line
• systemic treatment
• third line

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The aim of this systematic review was to assess the evidence for the available second-/third-line systemic therapies for malignant pleural mesothelioma.

• Eligible studies were obtained through searching appropriate databases and abstracts of the meetings.

• A total of 29 studies were considered eligible for this review and it included 3 Phase III studies, 18 Phase II studies and 8 retrospective studies.

• Of the Phase III studies, two studies have shown a progression-free survival benefit and none has achieved an overall survival benefit. Majority of the Phase II studies have not achieved sufficient satisfactory outcome to justify advancement to Phase III studies.

• The authors believe that the best salvage treatment for malignant pleural mesothelioma would be inclusion into appropriately designed clinical trials.

• In the absence of a clinical trial, gemcitabine and/or vinorelbine-based regimens could be considered. Moreover, pemetrexed re-challenge can be considered in selective pemetrexed-sensitive patients.