The efficacy of the frontline platinum-based combination chemotherapy in malignant peritoneal mesothelioma

Our plain-English summary of The efficacy of the frontline platinum-based combination chemotherapy in malignant peritoneal mesothelioma, by S.T. Kim, J.Y. Park, J. Lee, et al (Japanese Journal of Clinical Oncology, 2010).

The study

• Authors: S.T. Kim, J.Y. Park, J. Lee, J.O. Park, Y.S. Park, H.Y. Lim, W.K. Kang, S.H. Park
• Journal: Japanese Journal of Clinical Oncology
• Published: 2010;40(11):1031-6
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Malignant peritoneal mesothelioma is a rare neoplasm that accounts for ∼1 per 1 million has limited data regarding its frontline therapy. We investigated the treatment outcomes in patients with malignant peritoneal mesothelioma receiving frontline cisplatin-based combination chemotherapy.

Methods: We analyzed 14 patients with malignant peritoneal mesothelioma who had been treated by frontline cisplatin-based combination chemotherapy between January 2005 and March 2009. The chemotherapeutic agent added to platinum was gemcitabine in one patient, cyclophosphamide-doxorubicin in three patients and pemetrexed in 10 patients.

Results: The confirmed overall response rate was 35.7% and the disease control rate was 71.4%. In all patients, two complete responses and three partial responses were observed (overall response rate, 35.7%). Stable disease was observed in five patients (35.7%). The median progression free survival was 4.4 months (95% CI, 0.6-9.0) and the median overall survival was 20.1 months (95% CI, 12.7-28.5). There was significant differences for progression free survival (P = 0.031) according to the different chemotherapeutic agents (pemetrexed versus non-pemetrexed agents) added to platinum. Grade 3 or 4 hematologic toxicities included leukopenia in one patient and anemia in three patients. There were no Grade 3 or 4 non-hematologic toxicities or treatment-related deaths.

Conclusion: The platinum-based combination chemotherapy showed moderate activity and a favorable toxicity profile as a frontline treatment for patients with malignant peritoneal mesothelioma. Pemetrexed in combination with platinum showed improved survival outcomes as compared with other combination regimens combined with platinum.

In plain English

This was a retrospective, single-hospital study at Samsung Medical Center in Seoul, South Korea. The authors reviewed records of 14 patients with malignant peritoneal mesothelioma given platinum-based combination chemotherapy as first-line chemotherapy between January 2005 and March 2009. Five had already had debulking surgery. Ten received pemetrexed with platinum, three received cyclophosphamide–doxorubicin with platinum, and one received gemcitabine with platinum. The article does not discuss asbestos. Two patients had complete and three had partial responses (response rate 35.7%), and the disease control rate was 71.4%. Median progression-free survival was 4.4 months (95% CI 0.6–9.0), and median overall survival was 20.1 months (95% CI 12.7–28.5). Progression-free survival differed significantly (P = 0.031) between the 10 pemetrexed patients (median 12.3 months, 95% CI 2.5–22.1) and the four others (median 1.5 months, 95% CI 0.0–3.1). However, in multivariate analysis no characteristic, including regimen, independently predicted survival. Grade 3 or 4 blood-related side effects were leukopenia in one patient and anemia in three. There were no treatment-related deaths. The authors concluded the chemotherapy showed moderate activity and a favorable toxicity profile, and they noted the group was small and selected.

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: Retrospective study of patient records at a single institution (treatment outcomes case series)
• Who was studied: 14 patients with pathologically confirmed malignant peritoneal mesothelioma treated with frontline platinum-based combination chemotherapy at Samsung Medical Center, Seoul, Korea, January 2005 to March 2009. Median age was 54 years (range 40–69); 5 were male and 9 female
• Exposure: No asbestos exposure is reported. The study examined first-line chemotherapy: platinum combined with pemetrexed (10 patients), cyclophosphamide–doxorubicin (3 patients) or gemcitabine (1 patient)
• Main results:
  • Before chemotherapy, five patients had undergone debulking surgery; the others had diagnostic surgery, and none had prior radiotherapy
  • Among all 14 patients, there were 2 complete and 3 partial responses (overall response rate 35.7%). Five had stable disease (35.7%) and 5 had progressive disease (28.6%)
  • The disease control rate was 71.4% among all 14 patients
  • Response rates did not differ by baseline characteristics, including chemotherapy regimen
  • All 14 patients: median progression-free survival was 4.4 months (95% CI, 0.6–9.0) and median overall survival was 20.1 months (95% CI, 12.7–28.5)
  • Progression-free survival differed significantly (P = 0.031) between patients given pemetrexed and those given non-pemetrexed agents with platinum
  • Pemetrexed plus platinum group (n = 10): response rate 50% and disease control rate 80%. Median progression-free survival was 12.3 months (95% CI 2.5–22.1, Table 2), and median overall survival was not reached
  • Non-pemetrexed group (n = 4): median progression-free survival was 1.5 months (95% CI 0.0–3.1, Table 2) and median overall survival was 6.4 months (95% CI 0.0–19.2, Table 2)
  • In multivariate analysis, no clinical characteristic, including chemotherapy regimen, was an independent predictor of progression-free or overall survival
  • Grade 3 or 4 hematologic toxicity was leukopenia in 1 patient and anemia in 3 patients. There were no Grade 3 or 4 non-hematologic toxicities and no treatment-related deaths
• The authors' conclusion: The authors concluded that frontline platinum-based combination chemotherapy showed moderate activity and a favorable toxicity profile in malignant peritoneal mesothelioma
• Limitations the authors state:
  • This was a retrospective, single-institution study of a limited and selected group of patients
  • Most patients had good performance status, so patients in poorer condition may have been excluded from chemotherapy
  • The poor results in the non-pemetrexed group may partly reflect patient selection: all of those patients were male and none had debulking surgery
  • The results represent only a small group of patients

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, Peritoneal Mesothelioma, Neoplasm, Cisplatin, Gemcitabine, Doxorubicin, Pemetrexed (Alimta), Median Overall Survival.

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