Systemic chemotherapy has also been investigated. Pemetrexed in combination with cisplatin has shown survival improvement in patients with pleural mesothelioma. Data from uncontrolled studies suggest similar antineoplastic efficacy in patients with peritoneal mesothelioma,[50,51] and should be the standard of care for patients with unresectable malignant mesothelioma.
The disease control rate reported is 71.2%: it includes partial responses or stable disease. No complete responses are reported for this chemotherapy.[52]Other drug regimens used for unresectable disease are vinorelbine and gemcitabine, either alone or combined with platinum compounds.[51] The response rate of vinorelbine alone is 24%.[53] Irinotecan[54] and gefinitib[55] have not been shown to be effective when used alone.
Immunotherapy is used on an experimental basis, mainly for pleural mesothelioma.[56] Humanized anti-CD3 antibodies (OKT3),[57] cytotoxic T lymphocytes (CTL),[58] interferon alfa-2a,[59] and autovaccine[60] have all been used anecdotally for palliation of advanced peritoneal mesothelioma, but more data are needed before this therapy can be recommended. Radiation therapy has a limited role in peritoneal mesothelioma and it is not currently used.[61]For patients with confirmed MPM, radical resection is associated with better prognoses and should be pursued when possible. Other treatments for peritoneal mesothelioma include intensive loco-regional therapeutic strategies: cytoreductive surgery, hyperthermic intraoperative or early postoperative intraperitoneal chemotherapy, and immunotherapy.
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