Researchers from the UK and Australia involved in a multicenter randomized trial have concluded that chemotherapy for advanced pleural mesothelioma may not improve survival or quality of life. The details of this study appeared in the May 17, 2008 issue of The Lancet.¹

Pleural mesothelioma is a rare and lethal form of cancer caused by asbestos exposure. There are about 2,500 new cases a year in the United States. Because the disease is often advanced at the time of diagnosis, average survival for those with pleural mesothelioma has been significantly less than one year. Recent studies have suggested that chemotherapy can improve quality of life and prolong survival compared with supportive care measures.

The current study compared active symptom control (ASC), with one of two chemotherapy regimens (mitomycin, vinblastine, and cisplatin [MVP] or vinorelbine alone) in 409 patients with advanced pleural mesothelioma. The following table summarizes the main findings of this trial.

There were no differences in quality of life parameters between the three groups. These authors concluded that the addition of chemotherapy to supportive care did not affect survival or quality of life. However, there was a suggestion that vinorelbine could be more effective than supportive care or MVP chemotherapy.

Comments: These data show the lethality of mesothelioma despite current chemotherapy. It could be argued that these results were due to poor selection of chemotherapy drugs and that results would have been different if gemcitabine-based chemotherapy were used. However, most studies have shown only a modest benefit of chemotherapy for this disease.

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Reference:

¹ 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 randomized trial. The Lancet. 2008;371:1685-1694.