Almost all of the established cytotoxic agents have now been examined both as single-agents and in combination chemotherapy regimens as treatment approaches for malignant pleural mesothelioma (MPM). Until recently, only few agents have consistently produced objective response rates greater than 20%, and no agent has improved median survival beyond 10 months. The recent development of several new cytotoxic agents, such as the novel antimetabolite pemetrexed, has yielded encouraging results. In particular, pemetrexed produces response rates of up to 45%, and increases median survival to over 12 months when used in combination with cisplatin. This doublet-based chemotherapy regimen is now the standard therapy for the first-line treatment of MPM.
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