悪性胸膜中皮腫治療：ASCO臨床実践ガイドライン

Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline
Hedy L. Kindler, et al.
http://ascopubs.org/doi/full/10.1200/JCO.2017.76.6394


Recommendation 2.1: The recommended first-line chemotherapy for patients with mesothelioma is pemetrexed plus platinum. However, patients should also be offered the option of enrolling in a clinical trial (Type of recommendation: evidence based; Evidence quality: high; Strength of recommendation: strong)

アリムタ：ペメトレキセド＋プラチナ製剤を第一選択とする

Recommendation 3.1: The addition of bevacizumab to pemetrexed-based chemotherapy improves survival in select patients and therefore may be offered to patients with no contraindications to bevacizumab. The randomized clinical trial demonstrating benefit with bevacizumab used cisplatin/pemetrexed; data with carboplatin/pemetrexed plus bevacizumab are insufficient for a clear recommendation (Type of recommendation: evidence based; Evidence quality: high; Strength of recommendation: moderate)

ペメトレキセド・ベースの化学療法に、アバスチン：ベバシズマブ（Bevacizumab）を追加は選択的患者で禁忌のない場合、投与可


Recommendation 3.2: Bevacizumab is not recommended for patients with PS 2, substantial cardiovascular comorbidity, uncontrolled hypertension, age > 75, bleeding or clotting risk, or other contraindications to bevacizumab (Type of recommendation: evidence based; Evidence quality: intermediate; Strength of recommendation: moderate).
ベバシズマブはPS2、心血管併発、高血圧コントロール不良、75歳超、出血・血栓リスク、禁忌では推奨しない

Recommendation 4.0: In patients who may not be able to tolerate cisplatin, carboplatin may be offered as a substitute for cisplatin (Type of recommendation: evidence based; Evidence quality: intermediate; Strength of recommendation: strong).
シスプラチン、カルボプラチン耐用不能患者では、シスプラチンを除いて投与

Recommendation 5.1: Retreatment with pemetrexed-based chemotherapy may be offered in pleural mesothelioma patients who achieved durable (> 6 months) disease control with first-line pemetrexed-based chemotherapy (Type of recommendation: evidence based; Evidence quality: low; Strength of recommendation: moderate).
ペメトレキセド基本の再治療は、1stラインのペメトレキセド化学療法にてコントロールの６ヶ月超耐用可能な胸膜中皮腫患者で投与可能

Recommendation 5.2: Given the very limited activity of second-line chemotherapy in patients with mesothelioma, participation in clinical trials is recommended (Type of recommendation: evidence based; Evidence quality: intermediate; Strength of recommendation: strong).


Recommendation 5.3: In patients for whom clinical trials are not an option, vinorelbine may be offered as second-line therapy (Type of recommendation: evidence based; Evidence quality: low; Strength of recommendation: moderate).

Recommendation 6.1: In asymptomatic patients with epithelial mesothelioma and a low disease burden who are not surgical candidates, a trial of expectant observation may be offered before initiation of systemic therapy (Type of recommendation: evidence based; Evidence quality: low; Strength of recommendation: moderate).

Recommendation 6.2: Front-line pemetrexed-based chemotherapy should be given for four to six cycles. For patients with stable or responding disease, a break from chemotherapy is recommended at that point (Type of recommendation: evidence based; Evidence quality: low; Strength of recommendation: moderate).