Response to chemotherapy of brain metastases from malignant pleural mesothelioma

Our plain-English summary of Response to chemotherapy of brain metastases from malignant pleural mesothelioma, by M. Colleoni, G. Liessi, C. Avventi, et al (Tumori, 1996).

The study

• Authors: M. Colleoni, G. Liessi, C. Avventi, F. Pancheri, G. Sgarbossa, G. Vicario, P. Manente
• Journal: Tumori
• Published: 1996;82(5):456-8
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Brain metastases represent an uncommon complication in malignant pleural mesothelioma. A 55-year-old male suffering from malignant mesothelioma and pretreated with intracavitary chemotherapy and radiotherapy was submitted to systemic chemotherapy including lomustine, carboplatin, vinorelbine, fluorouracil and folates after diagnosis of bilateral cerebral deposits. The patient had an impressive response to chemotherapy, with complete regression of related symptoms. This case report represents the first on response to chemotherapy of brain metastases from mesothelioma. It points out that chemotherapy should be further explored in this subset of patients.

In plain English

This case report from Castelfranco Veneto, Italy, described a 55-year-old man with asbestos exposure and epithelial malignant pleural mesothelioma. In 1992 he had a non-radical pleurectomy with chemotherapy into the chest cavity, then systemic chemotherapy. In 1994 a chest relapse was treated with radiotherapy. In February 1995 a brain CT scan showed two lesions: 3 cm in the cerebellum and 2 cm paramedian. He then received carboplatin, vinorelbine, L-leucovorin and fluorouracil weekly for four weeks, with lomustine on day 1 only. Headache and vomiting improved within two weeks; in April the lesions had shrunk (partial remission), and symptoms had fully regressed by May. In June the paramedian deposit had regressed completely; minimal hypodensity remained at the cerebellar site. In September a new brain lesion appeared and palliative radiotherapy was given. Side effects were mainly grade III drops in blood counts, which in the second cycle led to doses being halved. The authors called this the first reported chemotherapy response of mesothelioma brain metastases. They concluded the schedule should be explored further in advanced mesothelioma, while noting the result was difficult to explain.

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 55-year-old man with epithelial malignant pleural mesothelioma and brain metastases, treated at City Hospital, Castelfranco Veneto, Italy, 1992 to 1995
• Exposure: A history of asbestos exposure. No fiber type, job or dose is given. The treatment studied was systemic chemotherapy with carboplatin, vinorelbine, L-leucovorin and fluorouracil given weekly for 4 weeks, with lomustine given only on day 1, followed by a 2-week rest.
• Main results:
  • In February 1995 a cerebral CT scan of the patient showed two metastatic brain lesions
  • The cerebellar lesion measured a maximum of 3 cm and the paramedian deposit a maximum of 2 cm
  • After the first two weeks of chemotherapy, the patient's headache and vomiting improved significantly
  • At the April 1995 reevaluation the lesions were significantly smaller (partial remission)
  • After a second cycle, symptoms had completely regressed by May 1995
  • In June 1995 the paramedian deposit had completely regressed, with minimal hypodensity remaining at the cerebellar site
  • In September 1995 the patient had headache and hemiparesis, a CT scan showed a new lesion, and palliative radiotherapy was given
  • Side effects were mainly myelotoxicity (lowered blood counts): grade III leukopenia after 4 weeks of the first cycle
  • Grade III thrombocytopenia and neutropenia after the first week of the second cycle led to later weekly doses being reduced to 50% of the baseline dose
  • Non-blood toxicity was minimal, consisting of grade I nausea-vomiting
• The authors' conclusion: The authors stated that, to their knowledge, this was the first report of a response to chemotherapy in brain metastasis from mesothelioma. They concluded that the activity seen, together with the lack of established regimens, prompted them to explore this schedule further in advanced mesothelioma.
• Limitations the authors state:
  • The authors said the result was difficult to explain, given the scarce published data on these drugs and their limited demonstrated activity in mesothelioma

Topics

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

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Malignant Mesothelioma, Carboplatin, Vinorelbine, Fluorouracil (5-FU), Bilateral, Mesothelioma.

Related studies

• Malignant mesothelioma with brain metastases — J.A. Kaye, A.M. Wang, et al. (1986)
• Brain metastases in malignant pleural mesothelioma. Case report and review of the literature — K.S. Sridhar, A.M. Hussein, et al. (1989)
• Brain metastases in malignant pleural mesothelioma — T. Yamagishi, N. Fujimoto, et al. (2016)
• Meningeal and brain metastases in primary malignant pericardial mesothelioma — U. Bohn, J.L. Gonzalez, et al. (1994)
• Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed — T. Agatsuma, T. Koizumi, et al. (2010)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)

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