Comparison of pemetrexed plus cisplatin versus gemcitabine plus cisplatin for the treatment of advanced malignant pleural mesothelioma and the role of PD - L1 as prognostic factor

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive tumor, closely linked to asbestos exposure. It remains a significant worldwide health problem because of its poor prognosis and increasing incidence. Most of the patients have advanced disease at diagnosis and are not eligible for multimodality treatment. Thus, therapy is generally palliative, improving symptoms and modestly increasing survival. Currently, following a randomized phase III study, the combination of cisplatin and pemetrexed is widely used for the systemic treatment of advanced disease. The combination of cisplatin and gemcitabine was widely used for MPM throughout the world before the combination of antifolates and platinum compounds. Some studies reported that the combination of platinum and gemcitabine is also a reasonable first–line option for the systemic therapy of MPM. No randomized trials have been conducted to directly compare the combination of cisplatin plus pemetrexed versus