Phillip J. Manno, MD, FACP

In their historical review of the topicof malignant mesothelioma, Drs.Antman, Hassan, Eisner, and colleaguespoint out that the naturalhistory of malignant pleural mesotheliomahas not changed “over the past2 decades.” We disagree and suggestthat it was altered with the discoverythat the combination of pemetrexed(Alimta) and cisplatin is active in thissetting.[1] Subsequently, the largestphase III trial ever conducted in pleuralmesothelioma showed that mediansurvival improved by nearly4 months for pemetrexed/cisplatinrecipients, compared to treatment withcisplatin alone (13 vs 9 months,P < .001). Based on these data, theUS Food and Drug Administrationapproved pemetrexed, cisplatin, andsupplementation with vitamin B12 andfolic acid for the treatment of pleuralmesothelioma, and this regimen is nowthe standard of care.[2]