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Results from a recent study published in the Journal of Clinical Oncology indicate that neoadjuvant chemotherapy appears promising for the treatment of patients with malignant mesothelioma.

Mesothelioma is a rare form of cancer in which cancer cells arise within the lining of the chest wall. It is often associated with asbestos exposure and may develop many years after exposure. Prognosis depends on how early the cancer is found and how aggressively it is treated. Treatment may include surgery, chemotherapy and radiation. Long-term survival for patients with mesothelioma remains dismal and research is ongoing in order to attempt to improve survival for these patients.

One type of therapy being evaluated in the treatment of mesothelioma is neoadjuvant chemotherapy. The idea behind neoadjuvant chemotherapy is to shrink the cancer prior to surgery so that more of the cancer may be removed. In addition, some experts believe that neoadjuvant chemotherapy may kill cancer cells that have spread in the body immediately, versus waiting for a patient to complete surgery and become medically fit enough to tolerate chemotherapy.

The recent trial consisted of 19 patients diagnosed with mesothelioma, 17 of whom were considered to have poor long-term outcomes. All patients who were eligible for the surgical removal of their cancer were treated with neoadjuvant chemotherapy. Chemotherapy consisted of 3 cycles of cisplatin and gemcitabine weekly for 3 of 4 weeks. Following chemotherapy, patients underwent surgery for removal of the affected lung and surrounding structures. Radiation after surgery was then considered for all patients.

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Results of the trial indicate that the anti-cancer response rate to neoadjuvant chemotherapy was 32%. Overall, chemotherapy was relatively well tolerated, with minimal side effects. Surgery was performed on 16 of the patients and 13 patients received radiation after surgery. The average survival time was 23 months, although 2 patients remained disease free at 38 and 41 months.

Researchers concluded that neoadjuvant chemotherapy appears promising for the treatment of malignant mesothelioma; however, further investigation is warranted. Patients are encouraged to speak to their physician regarding treatment options and participation in clinical trials. Sources of information regarding ongoing clinical trials include the National Cancer Institute (

Reference: Weder W, Kestenholz P, Taverna C, et al. Neoadjuvant Chemotherapy Followed by Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma. Journal of Clinical Oncology. 2004;22: 3451-3457.