Currently, therapeutic approaches vary in each institution. Common methods include palliative surgery, systemic chemotherapy, intra-abdominal chemotherapy and surgery cytoreducing with preoperative intraperitoneal chemotherapy.
The agents commonly used in chemotherapy regimens including various combinations of cisplatin, irinotecan, cyclophosphamide, doxorubicin, dacarbazine, gemcitabine and pemetrexed. Before 2003, most of the institutions relied on evidence from small phase II studies and patients treated with cisplatin and gemcitabine. This provided a median survival of 6-9 months. Since then, large trials have taken place and, more recently, has shown that the combination of cisplatin and pemetrexed leads to a median survival of 12-14 months. However, although encouraging, these results indicate that treatment of peritoneal mesothelioma with systemic chemotherapy still has a median survival of only 1 year. This is similar to what occurs in patients who are treated with a palliative approach. Therefore, their effectiveness as first line treatment is questionable. However, it is still a useful option for patients who are not appropriate surgical candidates.
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