Malignant Pleural Mesothelioma Chemotherapy Treatment: Systematic Review

Abstract

Introduction: Malignant pleural mesothelioma is a rare, aggressive câncer that is expected to increase in incidence by 2030. The best ways to treat this neoplasm are still under discussion. Objective: To synthesize the evidence of efficacy and safety of the different first-line chemotherapy regimens available for the treatment of malignant pleural mesothelioma. Method: The LILACS, MEDLINE, Scopus, Cochrane Controlled Trials Register and Web of Science bibliographic databases were used. Studies were sought in the grey literature. Eligibility criteria included randomized phase II or III trials of chemotherapy-naive patients with pleural mesothelioma who underwent any therapeutic regimen, compared to other chemotherapeutic regimens or active symptom control, and presenting overall survival, progression free survival, tumor response and toxicity as outcomes. All steps were performed independently by two reviewers. The review protocol was recorded in the International Prospective Register of Systematic Reviews (PROSPERO 2014: CRD42014014388). Results: Thirteen studies involving fourteen therapeutic regimens were included. The only chemotherapy regimen that presented superior to the comparator with statistical significance in the three efficacy outcomes was cisplatin + pemetrexed. Cisplatin + pemetrexed and cisplatin + gemcitabine presented more grades 3 and 4 toxicity cases. Conclusion: There is good evidence to recommend combinations of platinum and antifolate derivatives as a first-choice option in the chemotherapeutic treatment of pleural mesothelioma. Further clinical studies are needed to support decisions to incorporate antifolates in the routine treatment of this neoplasm in Brazil.