Treatment of malignant pleural mesothelioma. Medicinal and palliative options

Chemotherapy is an essential part not only for curative but also for palliative treatment concepts for malignant pleural mesothelioma (MPM). For the majority of patients with MPM palliative forms of treatment are the only option due to the extent of the disease, their age or the presence of comorbidities. The standard first line chemotherapy is the combination of pemetrexed and cisplatin which not only leads to a significant extension of survival but also to an improvement of quality of life with better lung function and reduction of tumor-linked symptoms. With increasing detection of molecular characteristics of MPM the number of targeted agents increases which show promising results in trials. Radiotherapy plays a sub-ordinate role in the palliative treatment of MPM. The significance of prophylactic radiation of puncture or drainage canals has not been clarified. Talc pleurodesis for the elimination of extensive, relapsing pleural effusion and a combined analgetic treatment are integral components of the palliative management of MPM. This article provides an overview of standards in medicinal, especially palliative systematic therapy of MPM, new substances and symptom-oriented treatment options. ©Springer- Verlag 2009.