Dramatic tumour response to pemetrexed single-agent in an elderly patient with malignant peritoneal mesothelioma: a case report

Our plain-English summary of Dramatic tumour response to pemetrexed single-agent in an elderly patient with malignant peritoneal mesothelioma: a case report, by G. Fasola, F. Puglisi, A. Follador, et al (BMC Cancer, 2006).

The study

• Authors: G. Fasola, F. Puglisi, A. Follador, M. Aita, S. Di Terlizzi, O. Belvedere
• Journal: BMC Cancer
• Published: 2006;6:289
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: To date, there is no standard treatment for unresectable malignant peritoneal mesothelioma; either best supportive care or systemic chemotherapy with palliative intent are accepted options.

Case Presentation: Here, we report the case of a 79-year old patient with malignant peritoneal mesothelioma who was treated with pemetrexed single-agent and obtained an impressive long-lasting response.

Conclusion: Single-agent pemetrexed is a treatment option for malignant peritoneal mesothelioma in selected elderly patients or in patients with unpaired performance status.

In plain English

This article is a case report from a university hospital in Udine, Italy. It described one 79-year-old man with malignant peritoneal mesothelioma (in the lining of the abdomen) that could not be removed by surgery. He had worked 7 years at a local port and 3 years in a motor factory but had no memory of direct exposure to asbestos. A chest CT showed no pleural abnormalities. A lymph node biopsy was consistent with a well differentiated biphasic tumour of mesothelial origin. From August 2004 he received the chemotherapy drug pemetrexed alone, every 3 weeks. Side effects were grade 2 at most, including neutropenia (a fall in a type of white blood cell), nausea and fatigue. After 8 cycles, a CT in April 2005 showed only a minimal residue of disease. The disease returned in August 2005, after a response lasting 11 months. Four more cycles stabilized it, and a CT in February 2006 confirmed stable disease. The authors concluded that single-agent pemetrexed may be considered for selected elderly or unfit patients with this disease. They said a prospective clinical trial should be conducted to confirm this. The report describes a single patient.

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 79-year-old man, a non-smoker, seen at the Department of Medical Oncology, University Hospital, Udine, Italy. He presented in April 2004 and was followed to February 2006. His diagnosis was malignant peritoneal mesothelioma, with a biopsy consistent with a well differentiated biphasic malignancy of mesothelial origin, and his chest CT showed no pleural abnormalities.
• Exposure: No asbestos exposure was identified. The patient had worked 7 years at a local port and 3 years in a motor factory but did not recall direct exposure to asbestos. No fiber type is reported. The treatment studied was single-agent pemetrexed at 500 mg/m2 intravenously every 3 weeks.
• Main results:
  • In this patient, after the first 2 cycles of pemetrexed, physical examination and CT showed a partial response.
  • In this patient, side effects during the first cycles were limited to grade 2 neutropenia, nausea and anorexia.
  • After a total of 8 cycles, abdominal CT in this patient showed a minimal residue of disease, and his weight had increased by about 10% since treatment start.
  • Peritoneal lesions reappeared on CT in August 2005, after a response lasting 11 months.
  • The patient was retreated with 4 cycles of pemetrexed, which resulted in disease stabilization. Stable disease was confirmed by CT in February 2006.
• The authors' conclusion: The authors concluded that their report suggests single-agent pemetrexed may be considered for selected elderly or unfit patients with malignant peritoneal mesothelioma.
• Limitations the authors state:
  • The authors stated that a prospective clinical trial would be needed to confirm this use of pemetrexed. They also noted that large trials are generally not feasible because the tumour is rare.

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), Peritoneal Mesothelioma, Unresectable, Chemotherapy, Palliative Care, Performance Status.

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• Survey and biological insights of pemetrexed-related therapeutic improvement in mesothelioma: The Nancy Centre of Biological Resources' Mesothelioma Cohort — F. Vlastos, G. Hillas, et al. (2009)
• Chemotherapy maintenance: an option for prolonged survival in malignant peritoneal mesothelioma? — S. Hofer, B. Sasse, et al. (2010)
• Molecular mechanism implicated in Pemetrexed-induced apoptosis in human melanoma cells — A. Buqué, J.S.H. Muhialdin, et al. (2012)
• Reduced folate carrier and folylpolyglutamate synthetase, but not thymidylate synthase predict survival in pemetrexed-treated patients suffering from malignant pleural mesothelioma — F. Mairinger, C. Vollbrecht, et al. (2013)
• Adaptation of a chemosensitivity assay to accurately assess pemetrexed in ex vivo cultures of lung cancer — S.L. Suchy, R.J. Landreneau, et al. (2013)

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