UOC di Oncologia Medica - Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
Curr Treat Options Oncol. 2019 Feb 21;20(3):23. doi: 10.1007/s11864-019-0616-7.
Unresectable or relapsed malignant pleural mesothelioma (MPM) has dismal prognosis. First-line combination therapy with pemetrexed and a platinum analog allows a modest survival benefit, while no clear therapeutic options exist for the second-line therapy. In this setting, pemetrexed seems to be the most active drug; however, the inclusion in front-line treatment limits its use in further lines. Nevertheless, rechallenge with one or both drugs used in first-line remains a feasible strategy for responder patients. Alternatively, only few cytotoxic drugs have demonstrated a mild activity in refractory MPM. Among other options, targeted therapy has unfortunately produced disappointing results as salvage treatment probably due to the lack of a clear understanding of the tumor biology. In contrast, recent data suggest moderate efficacy and mild toxicity of immunotherapy also for the treatment of MPM. The combination of checkpoint inhibitors with chemotherapy or other immunological agents seems promising and could really "raise the bar" in this setting.
无法切除或复发的恶性胸膜间皮瘤（MPM）预后不良。培美曲塞联合铂类药物的一线治疗可带来适度的生存获益，而二线治疗尚无明确的治疗选择。在此背景下，培美曲塞似乎是最有效的药物；然而，由于其在前一线治疗中的应用受限，其在进一步治疗中的应用受到限制。然而，对于应答患者，重新使用一线治疗中使用的一种或两种药物仍然是可行的策略。或者，只有少数细胞毒性药物在难治性 MPM 中显示出轻微的活性。在其他选择中，靶向治疗作为挽救治疗的效果令人失望，这可能是由于对肿瘤生物学缺乏明确的认识。相比之下，免疫治疗在治疗 MPM 方面也显示出中等疗效和轻微毒性。检查点抑制剂联合化疗或其他免疫制剂似乎很有前途，并可能在这种情况下“提高标准”。
