Single Agent Chemotherapy

Mesothelioma is relatively chemoresistant. Most single chemotherapeutic agents have demonstrated response rates less than 20% and are associated with significant toxicities. Although no single agent has been shown to have an effect on overall survival, the following single agents appear to be active against mesothelioma: 5-fluorouracil, methotrexate (high dose), timetrexate, doxorubicin, epirubicin, cyclophosphamide, ifosfamide, mitomycin C, Platinol® (cisplatin), interferon, and Alimta®. Single-agent therapy with vinorelbine may provide useful relief of symptoms with low toxicity. The accepted “standard” single agent for the treatment of mesothelioma is cisplatin. Recently, various drug combinations have been explored and appear to be more active than current single drug regimens.

Development of the chemotherapy drug Alimta® (pemetrexed) has constituted a major step forward in the treatment of mesothelioma. Alimta® is related to methotrexate and was evaluated as a single agent drug in a phase II multi-center trial carried out in the U.S., Germany, and Italy with a reported response rate of 16%.