Pemetrexed Maintenance Therapy Following Bevacizumab-Containing First-Line Chemotherapy in Advanced Malignant Pleural Mesothelioma: A Case Report and Literatures Review

Our plain-English summary of Pemetrexed Maintenance Therapy Following Bevacizumab-Containing First-Line Chemotherapy in Advanced Malignant Pleural Mesothelioma: A Case Report and Literatures Review, by X.Q. Jing, L. Zhou, X.D. Sun, et al (Medicine, 2016).

The study

• Authors: X.Q. Jing, L. Zhou, X.D. Sun, J.M. Yu, X. Meng
• Journal: Medicine
• Published: 2016;95(14):e3351
• Type of article: Case report, Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a lethal disease with poor prognosis. The combination of cisplatin and pemetrexed has been confirmed as the standard of care for nonoperable MPM. Data have shown that the adoption of pemetrexed maintenance therapy (PMT) following first-line treatment appears extremely promising.We describe a 57-year-old man diagnosed as advanced MPM. We treated this patient with PMT after first-line cisplatin-based bevacizumab-containing chemotherapy and residual tumor disappeared after 6 course of PMT. A perfect response and a long progression-free survival (PFS) were reached with tumor mass disappearing and 14 months duration of PFS.This case suggests that adding bevacizumab to standard first-line chemotherapy is feasible and that PMT could be promising and useful for treating advanced MPM. We further entail a review of the literature on the first-line treatment, continuation maintenance therapy, switch maintenance therapy, and second-line treatment of patients with advanced MPM.

In plain English

This article reports on a single patient and then reviews published research on drug treatment for advanced malignant pleural mesothelioma. The patient was a 57-year-old man treated in Shandong, China. The article does not mention any asbestos exposure. Surgery (pleurectomy/decortication) could not remove all of the tumor because it had invaded the inferior vena cava; bone metastasis found later raised the stage to IV. He received six cycles of cisplatin, pemetrexed and bevacizumab, then radiotherapy to the remaining mass (55 Gy in 31 fractions). The text reports partial response after cycles 2, 4 and 6, but a figure caption calls the disease stable after cycle 6. He then had six courses of pemetrexed alone as maintenance therapy. After that, the remaining mass disappeared, and a blood marker called NSE fell to the normal range. He declined further treatment and had no progression for 14 months from diagnosis. The authors concluded that adding bevacizumab tended to be favorable and that pemetrexed maintenance appeared promising but remains experimental. This describes one patient's course; the trial results in the review section come from other studies.

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 of one patient, with a literature review
• Who was studied: One 57-year-old man with advanced malignant pleural mesothelioma, treated at Shandong Cancer Hospital, a tertiary care hospital in Jinan, China. He was first staged III (T3N2M0) and later restaged IV because of bone metastasis. He had a 5-year smoking history beginning at age 30.
• Exposure: The article does not report any asbestos exposure or occupational history for the patient; the only exposure history given is 5 years of smoking. The report is about treatment: cisplatin (75 mg/m2), pemetrexed (500 mg/m2) and bevacizumab (7.5 mg/kg) every 21 days for 6 cycles, then radiotherapy, then pemetrexed (500 mg/m2) maintenance every 21 days for 6 courses.
• Main results:
  • Surgery could not remove a tumor mass because it had invaded the inferior vena cava.
  • Before treatment, the patient's serum neuron-specific enolase (NSE) level was 48.04 ng/mL (normal range 0 to 24 ng/mL).
  • The text reports partial response to first-line cisplatin, pemetrexed and bevacizumab after 2, 4 and 6 courses.
  • The Figure 3 caption conflicts with the text: it describes the disease as stable after 6 cycles of first-line chemotherapy.
  • Radiotherapy (tomotherapy) of 55 Gy in 31 fractions was given to the remaining mass. The text says the response stayed partial afterwards, while the Figure 3 caption says the disease remained stable.
  • After 6 courses of pemetrexed maintenance therapy, the remaining tumor mass disappeared.
  • The NSE level fell gradually during treatment, reached the normal range and stayed there.
  • The patient declined further treatment and had no disease progression for 14 months from the confirmed diagnosis.
• The authors' conclusion: The authors concluded that this patient had a 'perfect response and a long PFS'. They said adding bevacizumab to standard first-line treatment tended to be favorable, and that pemetrexed maintenance therapy appeared promising but still remains experimental and needs further investigation.

Topics

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

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Bevacizumab, Chemotherapy, Pleural Mesothelioma, Prognosis, Cisplatin, Progression-Free Survival.

Related studies

• A review of bevacizumab in the treatment of malignant pleural mesothelioma — S. Brosseau, S. Assoun, et al. (2017)
• Nintedanib in combination with pemetrexed and cisplatin for chemotherapy-naive patients with advanced malignant pleural mesothelioma (LUME-Meso): a double-blind, randomised, placebo-controlled phase 3 trial — G.V. Scagliotti, R. Gaafar, et al. (2019)
• Long progression-free survival by pemetrexed continuation maintenance therapy following cisplatin-based chemotherapy in malignant pleural mesothelioma — T. Takeda, H. Itano, et al. (2014)
• Randomized Study of Maintenance Pemetrexed Versus Observation for Treatment of Malignant Pleural Mesothelioma: CALGB 30901 — A.Z. Dudek, X. Wang, et al. (2020)
• A multicenter phase II study of cisplatin, pemetrexed, and bevacizumab in patients with advanced malignant mesothelioma — J.E. Dowell, F.R. Dunphy, et al. (2012)
• Correlation between TS, MTHFR, and ERCC1 gene polymorphisms and the efficacy of platinum in combination with pemetrexed first-line chemotherapy in mesothelioma patients — T. Powrózek, D.M. Kowalski, et al. (2014)

Browse more research in Medicine, or return to medical research.