Following the publication of a study in the May edition of The Lancet, it is now recognized that adding chemo to symptom relieving treatments, such as steroids, does not prolong life expectancy or improve the quality of life. However, one chemotherapy drug - vinorelbine - has been deemed worthy of further study.

In a study that recruited 409 mesothelioma patients (average age, 65) from treatment centers in the United Kingdom and Australia between 2001 and 2006, patients were randomly divided into three groups and given either active symptom control alone (that means no attempt was made to cure the disease, just to manage it); active symptom control plus a combination of the chemotherapy drugs mitomycin, vinblastine, and cisplatin (MVP); or active symptom control plus the chemotherapy drug, vinorelbine. None of the patients had received prior treatment with chemotherapy.

Results from the study showed no real improvement in the first two groups of patients. However, those patients receiving active symptom control and vinorelbine lived, on average, two months longer (9.5 months compared to 7.6 months) than those in the active symptom control group. The patients on vinorelbine also experienced a longer period without their cancer progressing.

Future studies should identify which patients benefit most from treatment—and how much they benefit—so that doctors can better target treatments. Research is also required to test out different drug combinations; for example, adding vinorelbine to other chemotherapy drugs, such as cisplatin or pemetrexed.

The Lancet (Free registration required)

Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CMB, Lowry E, et al. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomized trial. The Lancet. 2008;371:1685:1694.