Table 5 New approaches to treatment for mesothelioma
Agent/approachMechanism of actionTrial evidenceReference
Bevacizumab (Avastin)Monoclonal antibody vascular endothelial growth factor receptor agonist; angiogenesis inhibitorProven efficacy in lung, colon, breast cancer. Multicentre trial underway adding bevacizumab to gemcitabine and cisplastin126
Ranpirnase (Onconase)Anti-tumour ribonucleasePhase III trial of doxorubicin with or without ranpirnase nearly complete. Statins may reverse doxorubicin resistance127
Bortezomib (Velcade)Proteosome inhibitorProven efficacy in myeloma. Phase II (randomised) trial underway in mesothelioma128
Arginine depletionArgininosuccinate synthetase, a rate-limiting enzyme in arginine production is deficient in >50% of mesotheliomasPhase II clinical trial planned129
ImmunotherapyNewer targeted biological agents are under developmentInterleukin-2 and interferon disappointing130
Gene therapyAttractive concept but unlikely to be able to eradicate a solid tumour diagnosed late in natural historyGene therapy no practical use outside small trials. Role may be as part of multi-modality treatment131