The efficacy of pemetrexed and bevacizumab intrapleural injection for malignant pleural mesothelioma-mediated malignant pleural effusion

Our plain-English summary of The efficacy of pemetrexed and bevacizumab intrapleural injection for malignant pleural mesothelioma-mediated malignant pleural effusion, by D. Chen, X. Li, H. Zhao, et al (Indian Journal of Cancer, 2014).

The study

• Authors: D. Chen, X. Li, H. Zhao, Y. Fu, F. Yao, J. Hu, N. Du
• Journal: Indian Journal of Cancer
• Published: 2014;51 Suppl 3:e82-5
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The aim of the present study was to evaluate the efficacy and safety of pemetrexed chemotherapy combined with intrapleural injection of pemetrexed and bevacizumab in the treatment of malignant pleural mesothelioma (MPM)-mediated malignant pleural effusion, and analyze the objective response rate (ORR), the median progression-free survival (PFS) and the median overall survival (OS).

Methods: We analyzed the clinical data of 23 MPM patients with pleural effusion who were treated with a combination chemotherapy of pemetrexed at 500 mg/m 2 , on day 1 plus cisplatin (DDP) at 20 mg/m 2 on day 1-5 of each 21 days cycle, and concurrently, intrapleural injection of pemetrexed 0.5 g and bevacizumab 300 mg was administered on day 3 or day 4 after complete effusion drainage. ELISA test was applied to detect the vascular endothelial growth factor (VEGF) level in the pleural effusion and serum, and assess the ORR and survival.

Results: In the 23 evaluable patients, the VEGF level in the pleural effusion and serum was significantly decreased, P < 0.01, pleural effusion of 20 patients (86.96%) was controlled effectively. There were 8 complete responses, 7 partial responses, 5 stable disease and 3 progressive disease, the ORR was 65.21%, the disease control rate was 86.96%, the median PFS was 6 months, the median OS was 14.5 months, and the 1-year survival rate was 41.22%. Toxicities were generally mild and manageable; the major toxicities included myelosuppression, fatigue, and anemia, mainly were grade 1-2 which could be managed by symptomatic treatments.

Conclusion: The combination of pemetrexed chemotherapy with intrapleural injection of pemetrexed and bevacizumab is efficacious and safe for MPM pleural effusion, and results of the present study demonstrate some improvement in the PFS and OS. The expression of VEGF in the pleural effusion and serum plays a guiding role in monitoring the efficacy of bevacizumab in the treatment of malignant pleural effusion.

In plain English

This study described 23 patients with malignant pleural mesothelioma and fluid around the lung (pleural effusion), treated in Beijing from October 2008 to May 2012. All received intravenous pemetrexed and cisplatin chemotherapy. After the fluid was drained, they received pemetrexed and bevacizumab (an anti-VEGF antibody) injected into the chest cavity. There was no comparison treatment group. Thirty patients with non-cancerous effusion served only as VEGF comparisons. Effusion was effectively controlled in 20 patients (86.96%). Responses were judged on the effusion. Complete response (effusion and symptoms gone and stable more than 4 weeks) was reported in 8 patients (34.78%). Partial response (effusion reduced by 50%, symptoms improved, no regrowth over 4 weeks) was reported in 30.43%; the article gives this count as both 7 and 3. The objective response rate was 65.21%. Median progression-free survival was 7.0 months, median overall survival 13.5 months, and 1-year survival 41.22%. VEGF in fluid and blood fell after treatment. Severe (grade 3 or 4) neutropenia occurred in 6 patients. The authors concluded the combination was reliable, safe and feasible. Several numbers, including survival times, differ within the article.

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-group case series of treated patients (clinical data analysis, no comparison treatment group), with a separate group of non-cancer patients used only as controls for VEGF levels
• Who was studied: 23 patients with histologically confirmed malignant pleural mesothelioma and pleural effusion (13 men, 10 women, mean age 53.4 years), October 2008 to May 2012, First Affiliated Hospital of Chinese PLA General Hospital, Beijing. 30 patients with nonmalignant pleural effusion served as VEGF controls. Asbestos exposure of the patients was not reported.
• Exposure: Not an asbestos exposure study. The treatment studied was intravenous pemetrexed 500 mg/m2 on day 1 plus cisplatin 20 mg/m2 on days 1 to 5 of 21-day cycles, with injection of pemetrexed and bevacizumab 300 mg into the chest cavity after fluid drainage, repeated every 3 weeks for an average of 3 times.
• Main results:
  • Before treatment, VEGF in the 23 mesothelioma patients differed significantly from the nonmalignant effusion group (P less than 0.01).
  • In the mesothelioma patients, VEGF in pleural fluid and serum decreased after treatment (P less than 0.01 according to the figure legend). After treatment the levels were similar to the control group, with no statistically significant difference (P greater than 0.05).
  • Pleural effusion was effectively controlled in 20 of the 23 patients (86.96%).
  • Responses were defined by the effusion and symptoms. A complete response meant the effusion and symptoms disappeared and stayed stable more than 4 weeks.
  • A partial response meant the effusion was reduced by 50%, symptoms improved, and the remaining effusion did not grow over 4 weeks of observation.
  • By these effusion-based criteria, complete response occurred in 8 patients (34.78%) and partial response in 30.43%. The partial-response count is given as 7 in the abstract and 3 in the results text. The objective response rate was 65.21% and the disease control rate 86.96%.
  • Among the 23 patients, median progression-free survival was 7.0 months, median overall survival was 13.5 months, and the 1-year survival rate was 41.22%.
  • Quality of life improved in 18 patients (78.26%), stayed stable in 4 (17.39%), and worsened in 1 (4.35%).
  • Table 2 of side effects in the 23 patients lists grade 3 or 4 neutropenia in 6 patients, fatigue in 3, and nausea in 3. Nosebleed (3 patients) and high blood pressure (4 patients) occurred only at grade 1 or 2.
• The authors' conclusion: The authors concluded that local treatment with bevacizumab and pemetrexed is reliable, safe and feasible. They also concluded that VEGF levels could serve to monitor response to bevacizumab treatment of malignant pleural effusion.

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, Pleural Mesothelioma, Pleural Effusion, Chemotherapy, Progression-Free Survival, Median Overall Survival, Cisplatin.

Related studies

• 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)
• Third-space fluid distribution of pemetrexed in non-small cell lung cancer patients — P.H. Honoré, S.J. Joensen, et al. (2014)
• Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial — V.W. Rusch, R. Figlin, et al. (1991)
• Folylpoly-glutamate synthetase expression is associated with tumor response and outcome from pemetrexed-based chemotherapy in malignant pleural mesothelioma — D.C. Christoph, B.R. Asuncion, et al. (2012)
• Bevacizumab plus cisplatin/pemetrexed then bevacizumab alone for unresectable malignant pleural mesothelioma: A Japanese safety study — T. Nakano, K. Kuribayashi, et al. (2021)
• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)

Browse return to medical research.