➤ Bevacizumab is not recommended for patients with PS ≥2, substantial
cardiovascular comorbidity, uncontrolled hypertension, age >75,
bleeding or clotting risk or other contraindications to bevacizumab.
(Moderate Recommendation; EB-I)
➤ In patients who may not be able to tolerate cisplatin, carboplatin may be
offered as a substitute for cisplatin. (Strong Recommendation; EB-I)
➤ Re-treatment with pemetrexed-based chemotherapy may be offered
in pleural mesothelioma patients who achieved durable (>6 months)
disease control with first-line pemetrexed-based chemotherapy.
(Moderate Recommendation; EB-L)
➤ Given the very limited activity of 2nd line chemotherapy in patients with
mesothelioma, participation in clinical trials is recommended. (Strong
Recommendation; EB-I)
➤ In patients for whom clinical trials are not an option, vinorelbine may be
offered as second line therapy. (Moderate Recommendation; EB-L)
➤ In asymptomatic patients with epithelial mesothelioma and a low disease
burden who are not surgical candidates, a trial of expectant observation
may be offered before initiation of systemic therapy. (Moderate
Recommendation; EB-L)
➤ Frontline pemetrexed-based chemotherapy should be given for 4–6
cycles. For patients with stable or responding disease, a break
from chemotherapy is recommended at that point. (Moderate
Recommendation; EB-L)
➤ There is insufficient evidence to support the use of pemetrexed
maintenance in mesothelioma patients and thus it is NOT recommended.
(Strong Recommendation; EB-L)
Surgical Cytoreduction
➤ In selected patients with early stage disease, it is strongly recommended
that a maximal surgical cytoreduction should be performed. (Strong
Recommendation; EB-I)
➤ Maximal surgical cytoreduction as a single modality treatment
is generally insufficient; additional anti-neoplastic treatment
(chemotherapy and/or radiation therapy) should be administered. It
is recommended that this treatment decision should be made with
multidisciplinary input involving thoracic surgeons, pulmonologists,
medical and radiation oncologists. (Strong Recommendation; EB-I)
Treatment
