Objective To systematically evaluate the clinical effectiveness and safety of raltitrexed plus cisplatin in the treatment of malignant pleural mesothelioma (MPM) when compared with other chemotherapy regimens. Methods We electronically searched PubMed, Embase, The Cochrane Library and Chinese Biomedicine Database to March, 2007. Randomized controlled trials (RCTs) and quasi-RCTs were identified, and Revman 4.2.10 was applied for statistical analyses. Results One RCT involving 250 patients was included, which compared raltitrexed plus cisplatin versus cisplatin alone in the treatment of MPM. In the intention-to-treat population, the median survival time was statistically longer in the raltitrexed plus cisplatin group as compared to cisplatin alone group. (11.4 versus 8.8 months, P=0.048). The incidence of grade 3/4 toxicities was similar between the two groups. Conclusion The current evidence available showed that, the combination of raltitrexed and cisplatin may prolong the survival time for MPM patients, with a low incidence of grade 3/4 toxicities. However, more high-quality RCTs are required to further define its clinical effectiveness.
Objective To formulate an evidence-based treatment plan for a patient with malignant pleural mesothelioma.Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2007), PubMed (1996 to February 2007) and EMbase (1974 to February 2007) to identify the best available clinical evidence. Results Five randomized controlled trials, 4 systematic reviews and 1 health economic evaluation were included. According to the current evidence, as well as the patient’s clinical condition and preference, 5 cycles of raltitrexed plus cisplatin were given to the patient along with thoracic drainage and other symptomatic treatment. And the follow-up after 4 months indicated that this treatment plan was appropriate for the patient. Conclusion Evidence-based approaches helped us to prepare the most appropriate chemotherapy plan for this patient and will help improve the therapeutic results for patients with malignant pleural mesothelioma.
In recent years, immune checkpoint inhibitor therapy has changed the treatment of various malignant tumors. Immunotherapy for specific targets currently plays an important role in melanoma, lung cancer and other tumors. Malignant pleural mesothelioma (MPM) is an aggressive malignant tumor. Although the treatments include surgery, chemotherapy and radiotherapy, the clinical efficacy is limited, and the prognosis of advanced patients is poor. With the application of monoclonal antibodies such as programmed death 1/programmed death ligand 1 and cytotoxic T-lymphocyte antigen 4, MPM patients have more treatment options. And compared with traditional chemotherapy, immunotherapy may have the effect of improving survival and shrinking tumors. This article will summarize the current clinical trials of immunotherapy in MPM, and explain the current application and progress of immunotherapy in MPM from both single-agent immunotherapy and combined immunotherapy.