Since the US Food and Drug Administration (FDA) approved pemetrexed plus cisplatin for first-line treatment of mesothelioma in 2004, there has been a dearth of additional treatment options for this disease. Despite substantial effort, no other phase 3 study achieved a positive outcome for another 12 years, until the MAPS trial showed that the addition of bevacizumab to pemetrexed plus platinum improved progression-free and overall survival. Although it is not approved by regulatory agencies, bevacizumab is endorsed in treatment guidelines for patients with no contraindications to its use, with variable uptake depending on the geographical region. No drugs have been approved for previously treated patients, but pemetrexed retreatment, gemcitabine, or vinorelbine are widely used, based on findings from single-group phase 2 trials and retrospective single-centre series.
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