الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive tumor, closely linked to asbestos exposure. It remains a significant worldwide health problem because of its poor prognosis and increasing incidence.
Most of the patients have advanced disease at diagnosis and are not eligible for multimodality treatment. Thus, therapy is generally palliative, improving symptoms and modestly increasing survival.
Currently, following a randomized phase III study, the combination of cisplatin and pemetrexed is widely used for the systemic treatment of advanced disease. The combination of cisplatin and gemcitabine was widely used for MPM throughout the world before the combination of antifolates and platinum compounds. Some studies reported that the combination of platinum and gemcitabine is also a reasonable first–line option for the systemic therapy of MPM.
No randomized trials have been conducted to directly compare the combination of cisplatin plus pemetrexed versus cisplatin plus gemcitabine as first-line treatment of advanced MPM. In this randomized trial, we compared these two treatment regimens in terms of efficacy, toxicity, and quality of life.
This study indicates that combination of cisplatin plus pemetrexed is superior to ciplatin plus gemcitabine regarding the progression free survival and overall survival. Both regiemens were well tolerated and have similar toxicities. Also, there were no difeerence in effect between them on the quality of life.
Expression of programmed death ligand 1 (PD-L1) has been studied as a prognostic biomarker in a number of tumors given its central role in antitumoral immune response evasion. Five previously published analyses found PD-L1 positivity to be an adverse prognostic factor in MPM. However, thresholds for positivity levels have not been clearly defined for PD-L1, as a number of different cut-off values have been used.
This study has shown that PD-L1 was expressed in 82.4% of patients. All malignant pleural mesotheliomas with sarcomatoid and biphasic pathology had PD-L1 expression. PD-L1 positivity was asoociated with poor response to treatment, and shorter duration of survival.