Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed

Our plain-English summary of Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed, by T. Agatsuma, T. Koizumi, M. Yasuo, et al (Japanese Journal of Clinical Oncology, 2010).

The study

• Authors: T. Agatsuma, T. Koizumi, M. Yasuo, K. Urushihata, K. Tsushima, H. Yamamoto, M. Hanaoka, M. Fukushima, T. Honda, K. Kubo
• Journal: Japanese Journal of Clinical Oncology
• Published: 2010;40(12):1180-3
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The role of second-line and salvage chemotherapy in malignant pleural mesothelioma treatment is not yet established. We report a case of relapsed malignant pleural mesothelioma in which the patient failed to respond to pemetrexed-based chemotherapy but was successfully treated with gemcitabine and vinorelbine. The patient underwent a left extrapleural pneumonectomy. Three years later she developed anterior chest wall and retroperitoneal masses. Histological findings revealed metastases from the malignant pleural mesothelioma. Although two cycles of carboplatin plus pemetrexed chemotherapy were administered, she had progressive disease. Then, 1000 mg/m(2) gemcitabine and 25 mg/m(2) vinorelbine were administered every 2 weeks. The chemotherapy regimen was tolerated well, and the tumors were remarkably reduced. She was treated with 12 cycles of gemcitabine plus vinorelbine, and 8.5 months of progression-free survival was observed. Gemcitabine plus vinorelbine chemotherapy may be a candidate regimen for salvage chemotherapy against malignant pleural mesotheliomas.

In plain English

This was a case report from Shinshu University in Matsumoto, Japan, about one patient with malignant pleural mesothelioma (epithelial type): a 40-year-old woman first admitted in September 2004, with no obvious evidence of asbestos exposure noted. After a left extrapleural pneumonectomy, tumors appeared in 2007 in the left anterior chest wall and retroperitoneum and were confirmed as metastases from the mesothelioma. Two cycles of carboplatin plus pemetrexed, at reduced doses, were followed by progressive disease. From February 2009 she received gemcitabine (1000 mg/m2) and vinorelbine (25 mg/m2) every 2 weeks. The main side effects were grade 2 neutropenia and phlebitis, with none higher than grade 3. After four cycles the tumors shrank enough to count as a partial response, and her back pain improved. After 12 cycles, 8.5 months of progression-free survival was observed. The authors concluded the combination may be a candidate regimen for salvage chemotherapy in relapsed mesothelioma, noted that the earlier pemetrexed doses were insufficient, and called for prospective trials. A single case shows one patient's course, not a response rate.

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 (single patient)
• Who was studied: one 40-year-old woman with epithelial-type malignant pleural mesothelioma, admitted to Shinshu University Hospital, Matsumoto, Japan, in September 2004
• Exposure: No obvious evidence of asbestos exposure was noted for this patient. The exposure studied was salvage chemotherapy: intravenous gemcitabine 1000 mg/m2 plus vinorelbine 25 mg/m2 every 2 weeks, after earlier carboplatin plus pemetrexed failed.
• Main results:
  • After two cycles of carboplatin plus pemetrexed, given at reduced doses, a CT scan showed an enlarged tumor near the left adrenal gland, indicating progressive disease.
  • Gemcitabine plus vinorelbine was well tolerated. The main side effects were grade 2 neutropenia and phlebitis, and no toxicities higher than grade 3 were observed.
  • After four cycles of gemcitabine plus vinorelbine, the tumors showed significant reduction, corresponding to a partial response.
  • The patient's lower back pain improved and she no longer required oxycodone.
  • The patient received 12 cycles of gemcitabine plus vinorelbine, and 8.5 months of progression-free survival was observed.
• The authors' conclusion: The authors concluded that gemcitabine plus vinorelbine may be a candidate regimen for salvage chemotherapy against relapsed malignant pleural mesothelioma, and that this case suggested gemcitabine and/or vinorelbine could be active against mesothelioma previously treated with pemetrexed.
• Limitations the authors state:
  • The doses of carboplatin and pemetrexed given before gemcitabine plus vinorelbine were insufficient.
  • The response to the earlier carboplatin plus gemcitabine treatment could not be evaluated, so whether the earlier gemcitabine worked was unclear.
  • The authors stated that the optimal chemotherapy regimen and the role of salvage chemotherapy need to be evaluated in prospective clinical trials.

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, Gemcitabine, Vinorelbine, Pleural Mesothelioma, Pemetrexed (Alimta), Extrapleural Pneumonectomy (EPP), Carboplatin, Progression-Free Survival.

Related studies

• 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)
• A dose-finding study of gemcitabine and vinorelbine in advanced previously treated malignancies — J.P. Delord, E. Raymond, et al. (2000)
• Phase 2 study of sorafenib in malignant mesothelioma previously treated with platinum-containing chemotherapy — S. Papa, S. Popat, et al. (2013)
• Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma — P.A. Zucali, M. Perrino, et al. (2014)
• Triplet chemotherapy with cisplatin, gemcitabine and vinorelbine for malignant pleural mesothelioma — R. Maruyama, F. Shoji, et al. (2005)
• A phase II study of the combination of gemcitabine and imatinib mesylate in pemetrexed-pretreated patients with malignant pleural mesothelioma — P.A. Zucali, M. Perrino, et al. (2020)

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