If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  NCCN Outlines First Mesothelioma Treatment Guidelines: Presented at NCCN By Ed Susman HOLLYWOOD, Fla -- March 14, 2010 -- The first treatment algorithm for treating mesothelioma suggest that clinicians initiate therapy with either surgery followed by adjuvant chemotherapy or by induction chemotherapy followed by surgery, researchers said here at the 15th Annual National Comprehensive Cancer Network (NCCN) Conference on Clinical Practice Guidelines and Quality Cancer Care. The surgical choices are pleurectomy or extrapleural pneumonectomy, according to Lee Krug, MD, Memorial Sloan-Kettering Cancer Center, New York, New York, who presented the first guidelines here on March 13. In addition to the surgery, a mediastinal lymph node dissection is also recommended. Dr. Krug said surgeons have been using the more aggressive pneumonectomy option less frequently since the publication of a retrospective study of 603 patients showed a long-term survival advantage to the less intensive surgery.(1) Whatever surgery is selected, Dr. Krug said physicians believe that the removal of the tumour alone is not sufficient to protect the patient due to residual disease and a high rate of relapse. “Radiation can be used to decrease local recurrence,” he said. “Chemotherapy is added for systemic therapy either before or after surgery.” He noted that historically it has been believed that mesothelioma is resistant to chemotherapy -- and that remains true for the sarcomatoid variant of the disease. But recent trials that employ cisplatin and pemetrexed have shown a survival benefit in the disease, primarily contracted by asbestos workers. In a study, the combination of pemetrexed and cisplatin conferred about a 3-month overall survival advantage. Activity has also been observed with the use of vinorelbine and gemcitabine. The guidelines prefer a chemotherapy regimen of pemetrexed 500 mg/m2 on day 1 along with cisplatin 75 mg/m2 on day 1, administered every 3 weeks. Other front-line treatments that are listed are pemetrexed and carboplatin; cisplatin and gemcitabine; and pemetrexed monotherapy and vinorelbine monotherapy. For second-line treatment, Dr. Krug said the mesothelioma guideline committee suggested pemetrexed -- if not used as a first-line drug or vinorelbine or gemcitabine. The guidelines suggest that if surgery cannot be accomplished because of extensive cancer, the procedure should be abandoned. 1. Flores RM et al. J Thorac Cardiovasc Surg. 2008;135:620-626. [Presentation title: New NCCN Guidelines: Mesothelioma]
|
