In July of this year, The Lancet published an article describing the results of a study that compared the efficacy of a chemotherapy regimen utilizing mitomycin, vinblastine and cisplatin (MVP) or vinorelbine to a treatment regimen featuring best supportive care and active symptom control for patients with mesothelioma. The study showed that neither the MVP regimen nor the vinorelbine regimen showed any statistically significant improvement in extending patient life over the symptom control regimen. However, the authors concluded that vinorelbine deserves more study because there was some evidence to indicate a possible survival benefit to the treatment, even though it did not achieve statistical significance.

The latest edition of The Lancet has published a letter criticizing that study and its conclusions, as well as a reply by the authors of the original study. The letter attacked the design of the study and the pathology analysis conducted during it, as well as the authors’ conclusion that the use of vinorelbine to treat pleural mesothelioma deserved more research. The letter noted that while active symptom control and vinorelbine were more tolerable than pemetrexed (Alimta), the latter is still the only chemotherapy agent to demonstrate statistically significant improvements in median survival times for mesothelioma patients, so patients who can tolerate it should be treated with pemetrexed.

In their reply, the authors’ defend their study and their conclusion that vinorelbine warrants more research. They state that the recommendation to continue research on vinorelbine is warranted by their demonstration of some survival benefit, even though their results were not conclusive and were not presented as such. The authors state that a two month survival benefit in some of the patients treated with the chemo agent alone justifies the call for more research, especially considering how so few therapies have shown any benefit for the treatment of mesothelioma. They conclude that the future of mesothelioma diagnoses and treatment regimens is the identification of specific biomarkers and the development of truly targeted therapies.

Labels: chemotherapy, mesothelioma, treatments