Inclusion criteria

Patients must fulfill all of the following criteria to be eligible for the trial:

♦ Microscopically and immunohistochemically confirmed malignant pleural mesothelioma, including epithelial and other histological types, with a maximum time from date of diagnostic biopsy to randomization of three months

♦ Any symptomatic pleural effusion treated and brought under control by drainage, pleurodesis or pleurectomy

♦ CT scan to be performed within a month prior to randomization and, whenever possible, after pleurodesis

♦ Patients who have undergone surgical resection of mesothelioma are eligible provided two CT scans, six weeks apart, show stable or progressive disease

♦ No previous chemotherapy for mesothelioma

♦ Patients who have had local radiotherapy to a wound site after an exploratory thoracotomy are eligible

♦ No other disease or previous malignancy likely to interfere with the protocol treatments or comparisons

♦ WHO performance status 0-2

♦ WBC > 3 x 109/L, neutrophils > 1.5 x 109/L, platelets > 100 x 109/L, and no clinical evidence of infection

♦ Considered medically fit to receive chemotherapy; creatinine clearance > 50ml/min

♦ Patient has read the patient information sheet and signed the consent form

♦ Patient has completed a quality of life questionnaire before being told the treatment allocated

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