After a wide review of the role of palliative chemotherapy in non-resectable
malignant pleural mesothelioma, this chapter illustrates promising future research
directions. The role of thymidylate synthase and of excision repair crosscomplementation
group 1 expression has been found to significantly correlate with
prognosis. Several approaches to improve the efficacy of platinum salts are being
explored. The search for novel antifolates (i.e. pralaxate and GW1843) as well as
thymidilate synthase (i.e. plevitrexed and BGC 945) is ongoing. The platinum-based
regimens could benefit from the addition of bevacizumab and amatuximab, monoclonal
antibody against the vascular endothelial growth factor and mesothelin, respectively.
Keywords: Chemotherapy, maintenance therapy, pemetrexed, raltitrexed.
