Dr. Goldberg Discusses Treatment Approaches for Mesothelioma

Sarah B. Goldberg, MD, MPH, an assistant professor of medicine at the Yale School of Medicine and Yale Cancer Center, discusses traditional and emerging treatment approaches for patients with mesothelioma.

The majority of the patients who present with this extremely rare disease have advanced and unresectable mesothelioma, Goldberg says. Chemotherapy has shown benefit in these patients, and the standard frontline therapy is cisplatin plus pemetrexed, based on a randomized study done several years ago which evaluated the combination chemotherapy versus pemetrexed alone. Oftentimes, Goldberg notes, physicians will use carboplatin instead of cisplatin because the former is better tolerated in these patients.

Recently, there was a study which evaluated the addition of bevacizumab (Avastin)—the commonly used VEGF antiangiogenic agent—to the standard chemotherapy regimen. Results showed an improved survival by a few months, Goldberg says, but this approach is rarely used because patients with mesothelioma are often not candidates for bevacizumab.

Immunotherapy is also an emerging option in this space, showing benefit in patients who progress on standard chemotherapy. Ongoing studies are looking at the potential for combining immunotherapy with chemotherapy in the frontline setting.