Treatment Options for Recurrent Malignant Mesothelioma

Patients who have not received previous systemic therapy are candidates for first-line chemotherapy, chemoimmunotherapy, or dual immune checkpoint inhibition. For more information, see the Treatment of Advanced Malignant Mesothelioma (Stages II, III, and IV) section.

Systemic therapy for recurrent malignant mesothelioma previously treated with first-line chemotherapy or immunotherapy.

Systemic therapy for recurrent malignant mesothelioma previously treated with first-line chemotherapy or immunotherapy.

Gemcitabine in combination with ramucirumab.

Systemic therapy for recurrent malignant mesothelioma previously treated with first-line chemotherapy or immunotherapy.

Pemetrexed.

Systemic therapy for recurrent malignant mesothelioma previously treated with first-line chemotherapy or immunotherapy.

Nivolumab.

Systemic therapy for recurrent malignant mesothelioma previously treated with first-line chemotherapy or immunotherapy.

Vinorelbine.

Patients with disease recurrence are candidates for phase I and II clinical trials that evaluate new targeted therapies, biological therapies, chemotherapeutic agents, or physical approaches.[1-8]

Selected patients with localized disease recurrence may be candidates for additional chest-wall resection. One trial of 47 carefully selected patients at a single institution indicated that chest-wall resection could be safely performed. Time-to-recurrence from initial resection appeared to predict the expected survival benefit and was factored into decision making.[9][Level of evidence C1]