Local treatment of malignant pleural mesothelioma with intracavitary cytosine-arabinoside and cisplatin

Our plain-English summary of Local treatment of malignant pleural mesothelioma with intracavitary cytosine-arabinoside and cisplatin, by E. Aitini, E. Pasquini, G. Cavazzini, et al (Annals of Oncology, 1992).

The study

• Authors: E. Aitini, E. Pasquini, G. Cavazzini, P.P. Fattori, F. Smerieri
• Journal: Annals of Oncology
• Published: 1992;3(9):771-2
• Type of article: Letter
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter reported the use of chemotherapy given directly into the pleural cavity (intracavitary or intrapleural treatment) for malignant pleural mesothelioma. The authors were based at medical oncology departments in Mantova and Rimini, Italy. The letter does not say when the patients were treated.

Five patients were treated: four men and one woman, with a median age of 52 years (range 37-68). All had cytologically and histologically confirmed tumours, and none had a documented history of asbestos exposure. Three had previously received doxorubicin or epirubicin. After the pleural cavity was drained, cytosine arabinoside (Ara-C, 100 mg) and cisplatin (100 mg/m2) in 0.4 L of saline were instilled and drained again 4 hours later, with intravenous hydration and furosemide. Response and toxicity were assessed using WHO criteria.

The patients received a total of 27 courses (range 3-8). Three patients had a complete response, one a partial response and one progressive disease. Responses lasted 9 to 23 months, and survival ranged from 6 to 51 months. The main side effect was modest myelosuppression: the median white cell nadir was 2100/mm3 and the median platelet nadir 170,000/mm3. No fever or sepsis occurred, and two patients had mild nausea and vomiting. Two long-term survivors later developed peritoneal and hepatic involvement.

The authors stated that the small number of cases did not allow definitive conclusions. They suggested that this treatment could play an important role in local control of non-metastatic pleural mesothelioma, with minimal systemic toxicity.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter to the editor from two Italian hospitals described five patients (four men, one woman, median age 52) with confirmed malignant mesothelioma. None had a documented history of asbestos exposure. After draining the chest cavity, the doctors placed cytosine arabinoside (100 mg) and cisplatin (100 mg/mq) directly into the pleural space. The cavity was drained again four hours later. The patients received 27 courses in total, 3 to 8 each. Three patients had complete responses, lasting 15, 16 and 23 months. One patient had a partial response lasting 9 months, and one had progressive disease. Survival, counted from the time of diagnosis, ranged from 6 to 51 months, with one entry recorded as 25+ months. The main side effect, lowered blood counts, was generally modest. There was no fever or sepsis, and two patients had mild nausea and vomiting. Two patients later showed peritoneal or liver involvement, 50 and 23 months after diagnosis. The authors wrote that so few cases did not allow definitive conclusions. They suggested this therapy could help control non-metastatic pleural mesothelioma locally with minimal systemic toxicity.

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: Letter to the editor reporting a small case series of five patients treated with chemotherapy placed into the pleural cavity
• Who was studied: Five patients (four males, one female), median age 52 (range 37-68), with cytologically and histologically confirmed malignant mesothelioma, treated at medical oncology departments in Mantova and Rimini, Italy; dates of treatment not given
• Exposure: No patient had a documented history of asbestos exposure. The study examined a treatment: cytosine arabinoside (Ara-C) 100 mg and cisplatin 100 mg/mq, diluted in 0.4 L of saline and instilled into the pleural cavity, then drained 4 hours later
• Main results:
  • The five patients received a total of 27 treatment courses (range 3-8 per patient)
  • Responses by patient (Table 1): complete response (CR) in patients 1, 2 and 5; partial response (PR) in patient 3; progressive disease (PD) in patient 4
  • Duration of response by patient: 15, 23, 9 and 16 months for the four responders; none listed for the patient with progressive disease
  • Survival was measured from the time of diagnosis, not from the start of this treatment
  • Survival by patient, counted from diagnosis: 51, 26, 16, 6 and 25+ months
  • Myelosuppression (lowered blood counts) was the main side effect and was generally modest. Median white blood cell count nadir was 2100 per cubic millimetre (range 900-3400); median platelet count nadir was 170,000 (range 110,000-320,000)
  • Neither fever nor sepsis occurred; only two patients had mild nausea and vomiting
  • Patients 1 and 2 later showed peritoneal and hepatic involvement, respectively, at 50 and 23 months after diagnosis
• The authors' conclusion: The authors concluded that the small number of cases did not allow definitive conclusions about efficacy. They suggested this therapy could play a role in local control of non-metastatic pleural mesothelioma with minimal systemic toxicity. They also wrote that it did not seem able to prevent metastatic progression in long-term survivors, though it might delay it
• Limitations the authors state:
  • Only five patients, all with non-metastatic disease, were treated
  • The small number of cases does not allow definitive conclusions about real efficacy

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Cisplatin, Chemotherapy, Pleural Cavity, Asbestos Exposure, Doxorubicin.

Related studies

• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial — V.W. Rusch, R. Figlin, et al. (1991)
• Tumour Treating Fields in combination with pemetrexed and cisplatin or carboplatin as first-line treatment for unresectable malignant pleural mesothelioma (STELLAR): a multicentre, single-arm phase 2 trial — G.L. Ceresoli, J.G. Aerts, et al. (2019)
• Treatment of malignant pleural mesothelioma with cisplatin, mitomycin C and alpha interferon — S. Tansan, S. Emri, et al. (1994)
• Phase II study of first-line bortezomib and cisplatin in malignant pleural mesothelioma and prospective validation of progression free survival rate as a primary end-point for mesothelioma clinical trials (European Organisation for Research and Treatment of Cancer 08052) — M.E. O'Brien, R.M. Gaafar, 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)

Browse more research in Annals of Oncology, or return to medical research.