A systematic review and meta-analysis of second-line therapies for treatment of mesothelioma

This review provides essential landmarks for patients receiving second-line treatment, which can represent a basis for future clinical trials of systemic therapies in progressive/recurrent pleural malignant mesothelioma

Fausto Petrelli


Scholarcy highlights

  • Advanced malignant pleural mesothelioma is generally treated with platinum/pemetrexedbased first-line therapy
  • Among the agents used as second-line therapies, two were immunotherapies, 18 were targeted therapies, and 28 publications included various chemotherapy regimens
  • The benefit of second-line therapy is described in the phase three study that compared platinum/pemetrexed vs. platinum only, where post-study chemotherapy reduced the risk of death by 44%
  • Platinum-based doublets and pemetrexed-based therapy were associated with an overall response rate of roughly 30% and 18% respectively, but a similar median overall survival
  • The combination associated with the largest ORR, observed in the expanded access phase 3b study of Janne et al
  • Median OS was similar to historical data using pemetrexed-based chemotherapy, establishing that outcomes have not been improved during the past decade, as shown by our meta-regression analysis of survival at the time of publication
  • The outcome using salvage therapy has not evolved in the past decade, and the most active combinations appear to be those that are platinum-and/or pemetrexed-based, but with a median overall survival near similar to the effectsize calculated in the global population

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