Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience

Our plain-English summary of Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience, by G. Lainakis, F. Zagouri, E. Kastritis, et al (Tumori, 2011).

The study

• Authors: G. Lainakis, F. Zagouri, E. Kastritis, T.N. Sergentanis, G. Bozas, M.A. Dimopoulos, C.A. Papadimitriou
• Journal: Tumori
• Published: 2011;97(1):25-9
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Aims: Primary malignant peritoneal mesothelioma is a rare malignancy with an unfavorable prognosis. Pemetrexed has proven effective in the treatment of malignant mesothelioma, alone or in combination with platinum agents. In the present study, chemo-naïve patients were evaluated for the efficacy and safety of the pemetrexed-cisplatin combination.

Methods: Six patients with diffuse peritoneal mesothelioma were treated with 6 cycles of pemetrexed (500 mg/m2) and cisplatin (75 mg/m2). Chemotherapy was administered on an outpatient basis every 3 weeks.

Results: Complete response was observed in 2 patients (33%) and partial response was observed in 3 patients (50%). The estimated median overall survival was 24 months and the estimated median time to disease progression was 9.5 months. The regimen was well tolerated.

Conclusions: Though our data reflect a small sample size, pemetrexed plus cisplatin accomplished a particularly high clinical benefit rate on chemo-naïve patients.

In plain English

This article reported one hospital department's experience in Athens, Greece, treating six patients with primary malignant peritoneal mesothelioma (mesothelioma of the abdominal lining) who had not had chemotherapy before. Between November 2004 and July 2006, the patients, aged 28 to 66, received pemetrexed and cisplatin every 21 days for up to six cycles. All had first had abdominal surgery in which tumor removal was attempted. None had a history of asbestos exposure. Two patients (33%) had a complete response and three (50%) a partial response, a response rate of 83%. One patient showed no benefit and died 8.2 months after treatment began. The estimated median overall survival was 24 months and the estimated median time to disease progression was 9.5 months. There were no deaths from side effects. One patient had grade 4 thrombocytopenia (very low platelets) and did not receive the last cycle. The authors concluded the combination was active, safe and well tolerated in these patients. They stated that the small sample and lack of randomization were limitations and that larger studies should follow.

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: Single-institution case series of six patients treated with chemotherapy (no comparison group, not randomized)
• Who was studied: 6 chemo-naive patients (4 women, 2 men, aged 28 to 66 years) with primary malignant peritoneal mesothelioma, treated November 2004 to July 2006 at Alexandra Hospital, University of Athens, Greece. All had exploratory laparotomy with attempted cytoreductive surgery. 3 had epithelial mesothelioma and 3 mesothelioma not otherwise specified.
• Exposure: Pemetrexed 500 mg/m2 intravenously plus cisplatin 75 mg/m2, every 21 days for a maximum of 6 cycles, with vitamin B12, folic acid and dexamethasone pretreatment. The article reports that none of the patients had a history of asbestos exposure.
• Main results:
  • Complete response in 2 of the 6 patients (33%)
  • Partial response in 3 of the 6 patients (50%); overall response rate 83%
  • One patient showed no clinical or imaging benefit (stable disease) and died of progressive disease 8.2 months after the start of treatment
  • Estimated median overall survival among the 6 patients was 24 months (range 8.2 to 49.0+)
  • Estimated median time to disease progression among the 6 patients was 9.5 months (range 5.0 to 49.0+)
  • 35 cycles were given in total; 5 of the 6 patients received the planned 6 cycles
  • One patient had grade 4 thrombocytopenia and did not receive the last cycle; the same patient had grade 3 hypokalemia. No toxicity-related deaths occurred.
  • Four patients later received second-line chemotherapy for disease recurrence
• The authors' conclusion: The authors concluded that pemetrexed with cisplatin is an active, safe and well-tolerated combination in chemo-naive patients with malignant peritoneal mesothelioma, and that larger studies should follow.
• Limitations the authors state:
  • Small sample size and lack of randomization
  • The authors compared their response rate with other studies' and cautioned that the data come from different studies with possible unknown confounders

Topics

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

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pemetrexed (Alimta), Cisplatin, Peritoneal Mesothelioma, Prognosis, Malignant Mesothelioma, Median Overall Survival, Disease Progression.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
• Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma — S. Kruger, M.K. Angele, et al. (2014)
• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)
• Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience — J. Wong, A.L. Koch, et al. (2014)
• First-line chemotherapy with pemetrexed plus cisplatin for malignant peritoneal mesothelioma — E. Fujimoto, T. Kijima, et al. (2017)
• Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy — S. Bölükbas, C. Manegold, et al. (2011)

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