Malignant Pleural Mesothelioma

Regimen Options

Last Updated: 06/03/2024 See Details

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
INDUCTION PRIOR TO SURGERY
Stage I-III	cisplatin and pemetrexed	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Krug LM, et al. J Clin Oncol. 2009;27(18):3007-13. Vogelzang NJ, et al. J Clin Oncol. 2003;21(14):2636-44.
	carboplatin and pemetrexed	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Ceresoli GL, et al. J Clin Oncol. 2006;24(9):1443-8. Santoro A, et al. J Thorac Oncol. 2008;3(7):756-63.
ADJUVANT (INDUCTION NAÏVE)
Stage I-III	cisplatin and pemetrexed	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Krug LM, et al. J Clin Oncol. 2009;27(18):3007-13. Vogelzang NJ, et al. J Clin Oncol. 2003;21(14):2636-44.
	carboplatin and pemetrexed	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Ceresoli GL, et al. J Clin Oncol. 2006;24(9):1443-8. Santoro A, et al. J Thorac Oncol. 2008;3(7):756-63.
	cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Nowak AK, et al. Br J Cancer. 2002;87(5):491-6. van Haarst JM, et al. Br J Cancer. 2002;86(3):342-5.
ADVANCED/METASTATIC: INITIAL THERAPY
Stage I-IV	cisplatin and pemetrexed	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Krug LM, et al. J Clin Oncol. 2009;27(18):3007-13. Vogelzang NJ, et al. J Clin Oncol. 2003;21(14):2636-44.
	carboplatin and pemetrexed	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Ceresoli GL, et al. J Clin Oncol. 2006;24(9):1443-8. Santoro A, et al. J Thorac Oncol. 2008;3(7):756-63.
	cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Nowak AK, et al. Br J Cancer. 2002;87(5):491-6. van Haarst JM, et al. Br J Cancer. 2002;86(3):342-5.
	nivolumab and ipilimumab	Low	Low	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Bass P et al. https://doi.org/10.1016/S0140-6736(20)32714-8
ADVANCED/METASTATIC: SUBSEQUENT THERAPY
Stage I-III	pemetrexed If had good response to 1st line or naive	Low	Low	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Taylor P, et al. J Thorac Oncol. 2008;3(7):764-71. Jassem J, et al. J Clin Oncol. 2008;26(10):1698-1704.
	gemcitabine If had good response to 1st line or naive	Low	Low	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. van Meerbeeck JP, et al. Cancer. 1999;85(12):2577-82.
Stage IV (ECOG 0-2)	pemetrexed If had good response to 1st line or naive	Low	Low	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. Taylor P, et al. J Thorac Oncol. 2008;3(7):764-71. Jassem J, et al. J Clin Oncol. 2008;26(10):1698-1704.
	gemcitabine If had good response to 1st line or naive	Low	Low	NCCN Guidelines® for Malignant Pleural Mesothelioma. V.2.2017. van Meerbeeck JP, et al. Cancer. 1999;85(12):2577-82.

INDUCTION PRIOR TO SURGERY

Stage I-III

Evolent Pathways

cisplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

ADJUVANT (INDUCTION NAÏVE)

Stage I-III

Evolent Pathways

cisplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

ADVANCED/METASTATIC: INITIAL THERAPY

Stage I-IV

Evolent Pathways

cisplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pemetrexed

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

nivolumab and ipilimumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

ADVANCED/METASTATIC: SUBSEQUENT THERAPY

Stage I-III

Evolent Pathways

pemetrexed *If had good response to 1st line or naive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine *If had good response to 1st line or naive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Stage IV (ECOG 0-2)

Evolent Pathways

pemetrexed *If had good response to 1st line or naive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine *If had good response to 1st line or naive*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Pathways and Low-Value Regimens

Malignant Pleural Mesothelioma