The only curative treatment for mesothelioma is surgery. However, more than 70% of patients diagnosed with mesothelioma have advanced disease, which places them beyond the curative benefits of surgery. These patients are treated with chemotherapy following surgery with the main goal of treatment being to extend survival time and improve quality of life.

Researchers from England recently conducted a clinical trial to evaluate different timing of the administration of chemotherapy in patients with malignant mesothelioma. This trial included 43 patients who had undergone surgery and had stable disease symptoms for at least 4 weeks. Approximately half of the patients then received immediate MVP (mitomycin, vinblastine, cisplatin, or carboplatin), while the other half did not receive MVP until disease symptoms occurred.

Overall, patients treated with early chemotherapy had improved outcomes:
Median survival was 14 months for patients treated with immediate chemotherapy, compared with 10 months for those treated with delayed chemotherapy.
At one year, survival rates were 66% for those treated with immediate chemotherapy, compared with 36% for those treated with delayed chemotherapy.
Quality of life was generally better among patients treated with early chemotherapy.
Health resource utilization was comparable between the two groups of patients.
The researchers concluded that chemotherapy prior to the onset of disease symptoms improves outcomes compared to administering chemotherapy once symptoms have occurred in patients with mesothelioma.

Comments: This trial strongly supports early palliative treatment of patients with advanced inoperable mesothelioma.

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