Pemetrexed re-challenge in pleural malignant mesothelioma: an option for a subset of patients initially treated with pemetrexed-platinum doublets in the first-line setting?

Our plain-English summary of Pemetrexed re-challenge in pleural malignant mesothelioma: an option for a subset of patients initially treated with pemetrexed-platinum doublets in the first-line setting?, by G. Zalcman, E. Bergot, E. Lechapt (Lung Cancer, 2011).

The study

• Authors: G. Zalcman, E. Bergot, E. Lechapt
• Journal: Lung Cancer
• Published: 2011;72(1):1-2
• Type of article: Editorial
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was an editorial, not an original study. The authors commented on a retrospective observational study by Ceresoli and colleagues, published in the same issue of Lung Cancer, on giving pemetrexed-based chemotherapy again to patients with malignant pleural mesothelioma after earlier pemetrexed-based treatment. The editorial noted that asbestos exposure is the main factor in this cancer's development, and it reviewed earlier treatment results as background. As the editorial described it, the Ceresoli study included 32 patients in good general condition whose disease had not progressed for at least 3 months after first-line treatment. On re-treatment, 19% had an objective response and 31% had stable disease. One-year survival was 54.1% in patients whose progression-free survival after first-line treatment was greater than 12 months, and 18.8% in those whose progression-free survival was less than 12 months. The authors cautioned that the study was retrospective and not randomized, so its results should be treated with caution and as hypothesis-generating. They called for a prospective trial. The authors concluded that, without prospective randomized data, re-treating pemetrexed-sensitive patients could be considered an option for fit patients who have no investigational treatment available.

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: Editorial commenting on a retrospective observational study by Ceresoli and colleagues; no original data
• Who was studied: The authors studied no patients. The editorial discusses the Ceresoli series of 32 malignant pleural mesothelioma patients. These patients had performance status 0-1, had not progressed for at least 3 months after first-line pemetrexed-based chemotherapy, and were re-treated with it during a five-year period.
• Exposure: No asbestos exposure was studied. The editorial states that asbestos exposure is the main factor in the development of malignant pleural mesothelioma and names no fiber types. The treatment discussed is re-treatment with pemetrexed-based chemotherapy.
• Main results:
  • As reported in the editorial for the Ceresoli study: 19% of re-treated patients had an objective response and 31% had stable disease.
  • As reported in the editorial for the Ceresoli study: one-year survival from the start of re-treatment was 61.5% in patients re-treated in the second-line setting.
  • As reported in the editorial for the Ceresoli study: one-year survival was 18.8% in patients with progression-free survival under 12 months after first-line chemotherapy, and 54.1% in those with progression-free survival over 12 months.
  • As reported in the editorial for the Ceresoli study: median progression-free survival was 3.9 months and median overall survival was 10.3 months from the start of re-treatment.
  • As reported in the editorial for the Ceresoli study: 3 patients had grade 3 to 4 hematological toxicity and one patient had febrile neutropenia.
• The authors' conclusion: The authors concluded that, in the absence of prospective randomized data, re-treating sensitive patients with pemetrexed-based therapy could be considered an option for fit patients for whom no investigational treatment is available. Elsewhere the editorial describes 'pemetrexed-sensitive' patients as those with a long progression-free survival after front-line treatment. The authors called for a prospective trial.
• Limitations the authors state:
  • The authors state that, because the Ceresoli study was retrospective and non-randomized, its results must be considered with caution and as hypothesis-generating.

Topics

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

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Malignant Mesothelioma.

Related studies

• Molecular resistance fingerprint of pemetrexed and platinum in a long-term survivor of mesothelioma — O.D. Røe, A. Szulkin, 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)
• Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy — G. Toyokawa, M. Takenoyama, et al. (2014)
• Interaction and cross-resistance of cisplatin and pemetrexed in malignant pleural mesothelioma cell lines — M. Kitazono-Saitoh, Y. Takiguchi, et al. (2012)
• Pemetrexed for malignant pleural mesothelioma: Is it a standard second-line therapy? — K. Tamura, Y. Fujiwara (2010)
• Retreatment with pemetrexed-based chemotherapy in patients with malignant pleural mesothelioma — G.L. Ceresoli, P.A. Zucali, et al. (2011)

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