Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma

Our plain-English summary of Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma, by S. Kruger, M.K. Angele, S. Reu, et al (Anti-cancer Drugs, 2014).

The study

• Authors: S. Kruger, M.K. Angele, S. Reu, K. Sotlar, A. Graser, M. Haas, M. Albertsmeier, H.J. Stemmler, V. Heinemann, L.H. Lindner, S. Boeck
• Journal: Anti-cancer Drugs
• Published: 2014;25(7):854-6
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare disease. Although most patients eligible for surgery undergo cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy, the role of perioperative systemic chemotherapy still remains undefined. Here we report the case of a 52-year-old female patient with advanced sarcomatoid DMPM. After five cycles of systemic pemetrexed and cisplatin, along with two cycles of regional hyperthermia, tumor resection with histomorphological examination showed a complete pathological response. We therefore conclude that there is a subgroup of DMPM patients that might benefit from systemic neoadjuvant chemotherapy with pemetrexed and cisplatin.

In plain English

This case report described one 52-year-old woman treated in Munich for sarcomatoid peritoneal mesothelioma, a cancer of the abdominal lining. The article does not report any asbestos exposure history. In January 2013, CT showed an 11.6 by 7.6 cm tumor inside the abdomen that had grown into her left kidney, colon and small intestine. Before surgery she received pemetrexed and cisplatin chemotherapy with regional hyperthermia (heat treatment). The hyperthermia was poorly tolerated and was stopped in cycle 3. Drug doses were cut to 70% because of low white blood cell counts. After five cycles she had severe side effects, and CT showed only a minor decrease in tumor burden. In July 2013 surgeons removed the tumor along with parts of the bowel and the left kidney. No living tumor cells were found, and six lymph nodes were tumor free. The authors classified this as a complete pathological response. In February 2014 a PET-CT scan showed no evidence of remaining tumor or recurrence. The authors concluded there could be a subgroup of patients with initially inoperable tumors who might benefit from chemotherapy before surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 52-year-old white woman referred to a cancer center in Munich, Germany, in January 2013. She was diagnosed with sarcomatoid peritoneal mesothelioma.
• Exposure: The article reports no asbestos or other exposure history. What it studied was treatment before surgery: pemetrexed (500 mg/m2) on day 1 plus cisplatin (40 mg/m2), combined with regional hyperthermia on days 1 and 3.
• Main results:
  • At diagnosis, CT showed an 11.6 by 7.6 cm intraperitoneal tumor with multiple smaller intraperitoneal lesions. The tumor infiltrated the left kidney, colon and small intestine.
  • Both drugs had to be reduced to 70% of the dose in cycle 3 because of pronounced leukocytopenia (low white blood cell count).
  • Regional hyperthermia was poorly tolerated and was discontinued in cycle 3.
  • After five cycles the patient's general condition had worsened. She had grade II mucositis, leukocytopenia and thrombocytopenia up to grade IV, and grade III progressive renal insufficiency.
  • After five cycles, CT without contrast showed only a minor decrease in tumor burden.
  • In July 2013 the surgeons performed en-bloc tumor removal, partial resection of the small intestine, left nephrectomy and left hemicolectomy. No peritonectomy was performed.
  • No vital tumor cells were found in the resected specimen, and the six lymph nodes analyzed were tumor free. The response was classified as a complete pathological response.
  • At the last examination in February 2014, the patient had recovered well and received no further adjuvant treatment. A PET-CT scan showed no evidence of residual vital tumor tissue or recurrence.
  • The authors noted that conventional CT imaging did not adequately assess response to the preoperative chemotherapy in this case. They suggested PET imaging could potentially be a more appropriate staging tool.
• The authors' conclusion: The authors concluded that their case suggests there could be a subgroup of patients with tumors initially deemed unresectable who might benefit from preoperative systemic chemotherapy followed by surgery.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Cisplatin, Sarcomatoid, Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Chemotherapy, Neoadjuvant Chemotherapy.

Related studies

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• Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience — G. Lainakis, F. Zagouri, et al. (2011)
• A feasibility study of induction pemetrexed plus cisplatin followed by pleurectomy/decortication aimed at macroscopic complete resection for malignant pleural mesothelioma — M. Shimokawa, S. Hasegawa, et al. (2013)
• Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural mesothelioma — J. Green, Y. Dundar, et al. (2007)
• Nursing considerations for administering pemetrexed (Alimta) in combination with cisplatin for malignant pleural mesothelioma — K.K. Orbaugh (2004)
• The efficacy of the frontline platinum-based combination chemotherapy in malignant peritoneal mesothelioma — S.T. Kim, J.Y. Park, et al. (2010)

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