confirmed histologically cytologically diagnosis metastatic patients melanoma cancer pathologically carcinoma pancreatic adenocarcinoma histologically confirmed cytologically metastatic ductal advanced diagnosis patients exist longer measures curative standard effective palliative unresectable histologically confirmed colorectal histologically confirmed cytologically metastatic adenocarcinoma cancer unresectable diagnosis patients mesothelioma pleural malignant peritoneal histologically mpm confirmed pemetrexed cytologically unresectable