Malignant mesothelioma: Medical oncology: standards, new trends, trials—the French experience

Clinical trials investigating new trends in the treatment of stage I and II malignant mesothelioma have shown both intra-pleural immunotherapy and systemic chemo-immunotherapy to be efficacious. Intra-pleural gamma-interferon (γ-IFN) therapy was associated with tolerable toxicity and an overall response (ORR) rate of 19%, while treatment with intra-pleural recombinant interleukin-2 (IL-2) was more toxic, but yielded an ORR of 47% in phase I trial and 55% in a phase II study. The association of intravenous cisplatin and subcutaneous α-interferon (α-IFN) was also associated with an encouraging ORR of 40% and a median survival of 12 months. Treatment with cisplatin, α-IFN and mitomycin C was associated with moderate toxicity and an ORR of 21% and a median survival of 12 months. The association of cisplatin, α-IFN and IL-2 was, however, extremely toxic and resulted in an ORR of 15%. The majority of patients responding to intra-pleural immunotherapy and systemic chemo-immunotherapy had epithelial type mesothelioma. The most encouraging results obtained from trials investigating systemic chemotherapy were following treatment with cisplatin, 5-fluorouracil, mitomycin C and etoposide, where an ORR of 38% and an overall median survival rate of 16 months were achieved. Toxicity was mainly haematological and tolerable.