**Author details**

114 Malignant Mesothelioma

first-line.

cisplatin.

patients (Emri et al., 2011).

between the two arms.

**6. Conclusion** 

the early relapses.

population, and radiotherapy in 29 (54%) patients.

the neoadjuvant treatement of malignant mesothelioma patients.

We observed a higher incidence of grade 2-3 cumulative asthenia and worsening of performance status in the subgroup of patients who received cisplatin rather than carboplatin. Furthermore the postoperative mortality was 4% among patients treated with cisplatin compared to 0% among patients who received carboplatin in the induction chemotherapy regimen. We observed no difference in terms of disease control rate and progression free survival between the two treatment arms, while a longer overall survival (118 *versus* 66 weeks) was shown in patients treated with carboplatin rather than cisplatin. At the multivariate analysis, non-epithelial histology and cisplatin-based chemotherapy were associated to a worse prognosis. It is possible that a less aggressive chemotherapy regimen could improve the outcome of trimodality treatment, and allows second-line treatments to a higher proportion of patients. In our study, in fact, at the time of disease progression 37% of the patients previously treated with cisplatin received a second-line treatment, compared to 58% of the patients treated with carboplatin in the

Second line chemotherapy could have an impact on overall survival of mesothelioma patients, as already shown by Manegold and colleagues in the retrospective analysis of patients from the phase III study by Vogelzang in 2003 (Manegold et al., 2005). Another explanation for the longer survival in patients treated with carboplatin might be the higher number of sarcomatoid mesothelioma patients in the subgroup of patients treated with

As far as the doublet carboplatin and pemetrexed doublet concerns, another group recently compared that regimens to cisplatin plus pemetrexed in 54 malignant pleural mesothelioma

Chemotherapy consisted of pemetrexed plus carboplatin in 34 patients and plus cisplatin in 20 patients; median number of cycles was 6. Surgery was performed in 41% of the study

Median overall survival in all the 54 patients was 16 months. When the authors compared overall survival in the two treatment subgroups, they observed a significantly longer survival in patients treated with carboplatin (20 months compared to 15 months in cisplatinsubgroup), while no difference in terms of time to relapse and response rate was observed

On the basis of those results, prospective randomized clinical trials should be designed to evaluate toxicity profile, response rate, survival data of different chemotherapy regimens in

Despite the improvement in diagnosis and treatment, malignant pleural mesothelioma patients still have a dismal prognosis, because of the low response rate to chemotherapy and Giulia Pasello and Adolfo Favaretto *Second Medical Oncology Dept., Istituto Oncologico Veneto, Italy* 
