Malignant pleural mesothelioma (MPM) is a locally invasive
malignancy, but only a minority of patients can benefit by surgical resection. Among chemotherapeutic agents only
vinorelbine,
edatrexate,
gemcitabine and
raltitrexed have demonstrated response rates >20%. The largest randomised trial in MPM showed an improved median survival with
cisplatin and
pemetrexed versus
cisplatin alone from 9.3 to 12.1 months. For the present overview about 70 requests of information were sent to the major European centres of thoracic oncology. The most widespread study treatment in Europe is an 'Extended Access Program (EAP)' evaluating
pemetrexed alone or combined with
cisplatin or
carboplatin with about 1500 enrolled patients. Two other international randomized studies compare
pemetrexed plus best supportive care (BSC) versus BSC alone, and the role of
Ranpirnase (
Onconase) in MPM. Important national trials are ongoing: in the UK the addressed questions were the role of radical surgery (MARS Trial), the role of
chemotherapy (MS-01 trial) and the role of VATS on active treatment of
pleural effusion. In Switzerland the SAKK group phase III study explores in a comparative way the value of hemithoracic
radiotherapy after primary treatment with
cisplatin/
pemetrexed followed by surgery. In Italy, 2 phase II trials of
neoadjuvant chemotherapy (
pemetrexed plus
cisplatin in Rome,
pemetrexed plus
carboplatin in Padua) followed by surgery and
radiotherapy are active. With the important exception of UK, the most evident
element is the overwhelming presence of
pemetrexed in the ongoing and future clinical trials.
Pemetrexed has influenced not only the clinical practice, but also the patient enrolment in clinical trials.