Triplet chemotherapy with cisplatin, gemcitabine and vinorelbine for malignant pleural mesothelioma

Our plain-English summary of Triplet chemotherapy with cisplatin, gemcitabine and vinorelbine for malignant pleural mesothelioma, by R. Maruyama, F. Shoji, T. Okamoto, et al (Japanese Journal of Clinical Oncology, 2005).

The study

• Authors: R. Maruyama, F. Shoji, T. Okamoto, T. Miyamoto, T. Miyake, T. Nakamura, J. Ikeda, Y. Aoki, H. Wataya, H. Asoh, Y. Ichinose
• Journal: Japanese Journal of Clinical Oncology
• Published: 2005;35(8):433-8
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The incidence of malignant pleural mesothelioma (MPM) is expected to increase due to delayed control of occupational exposure to asbestos in Japan. We investigated the use of triplet combination chemotherapy with cisplatin (CDDP), gemcitabine (GEM) and vinorelbine (VNR) for the treatment of Japanese patients with MPM.

Methods: From December 2000 to August 2003, 12 patients received the following regimen: CDDP 40 mg/m(2), GEM 800 mg/m(2) and VNR 20 mg/m(2) on days 1 and 8 every 4 weeks. Among the 12 patients, six selected patients underwent an extrapleural pneumonectomy (EP) after a median of three cycles of triplet chemotherapy.

Results: The overall response rate for all patients and the response rate for chemotherapy-naive cases were 58 and 67%, respectively. The median survival time and survival rate at 2 years for all patients were 11 months and 50%, respectively. The 2-year survival rates for the patients with and without EP were 83.3 and 16.7%, respectively.

Conclusions: Triplet chemotherapy with CDDP, GEM and VNR was thus found to be highly effective for patients with MPM and its toxicity was manageable. A multi-institutional phase II trial is now being planned to establish the effectiveness of this new regimen in chemotherapy-naive patients with MPM.

In plain English

This single-center study at the Kyushu Cancer Center in Fukuoka, Japan, gave three chemotherapy drugs (cisplatin, gemcitabine and vinorelbine), on days 1 and 8 every 4 weeks, to 12 patients with malignant pleural mesothelioma between December 2000 and August 2003. Seven of the 12 had asbestos exposure; fiber types and jobs were not described. Tumors shrank (complete or partial response) in 7 of 12 patients, or 58% (95% confidence interval 30 to 86%). In the 9 patients with no previous chemotherapy, they shrank in 6, or 67% (95% confidence interval 36 to 98%). Severe (grade 3 to 4) neutropenia, a drop in infection-fighting white blood cells, occurred in 92%. There were no treatment-related deaths. Six selected patients had extrapleural pneumonectomy, an operation removing the lung and its lining; none died around the time of surgery. Median survival was 11 months for all patients, with median follow-up of 13 months. The estimated 2-year survival rate was 50%. Estimated 2-year survival was 83.3% with surgery and 16.7% without. The authors concluded the regimen was highly effective with manageable toxicity, and planned a multi-institutional phase II trial.

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-center prospective treatment study (single-arm chemotherapy trial), with surgery (extrapleural pneumonectomy) for selected patients after chemotherapy
• Who was studied: 12 patients with histologically proven malignant pleural mesothelioma, Kyushu Cancer Center, Fukuoka, Japan, December 2000 to August 2003; median age 53 (range 34–67); 11 male, 1 female; 9 had no prior treatment
• Exposure: The study examined a treatment, not asbestos exposure. Patients received cisplatin 40 mg/m2, gemcitabine 800 mg/m2 and vinorelbine 20 mg/m2 on days 1 and 8 every 4 weeks. Asbestos exposure history was recorded as yes in 7 patients (58%) and no in 5 (42%). No fiber types, products or jobs are given.
• Main results:
  • Overall response rate was 58% for all 12 patients (95% confidence interval 30–86) and 67% for the 9 chemotherapy-naive patients (95% confidence interval 36–98). Among all patients there was 1 complete response, 6 partial responses, 4 stable disease and 1 progressive disease.
  • Grade 3–4 leukopenia, neutropenia, anemia and thrombocytopenia occurred in 50%, 92%, 33% and 17% of patients, respectively. No toxic deaths occurred.
  • Six of the 12 patients were eligible for extrapleural pneumonectomy after a median of three chemotherapy cycles. There were no perioperative deaths and no major morbidity except thoracic empyema in one patient.
  • Median survival was 11 months for all patients and 6 months for patients who did not undergo extrapleural pneumonectomy. Median follow-up was 13 months (range 4–43).
  • Overall 2-year survival, estimated with the Kaplan–Meier method, was 50%. The 2-year survival rate was 83.3% for patients with extrapleural pneumonectomy and 16.7% for those without.
• The authors' conclusion: The authors concluded that the cisplatin, gemcitabine and vinorelbine triplet was highly effective for malignant pleural mesothelioma with manageable toxicity, and was feasible as induction before extrapleural pneumonectomy. A multi-institutional phase II trial was being planned.

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, Cisplatin, Gemcitabine, Vinorelbine, Pleural Mesothelioma, Occupational Exposure, Extrapleural Pneumonectomy (EPP), Median 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)
• Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed — T. Agatsuma, T. Koizumi, et al. (2010)
• A biomarker profile for predicting efficacy of cisplatin-vinorelbine therapy in malignant pleural mesothelioma — Z.G. Zimling, J.B. Sørensen, et al. (2012)
• A phase II trial of low-dose gemcitabine in a prolonged infusion and cisplatin for malignant pleural mesothelioma — V. Kovac, M. Zwitter, et al. (2012)
• Low ERCC1 expression in malignant pleural mesotheliomas treated with cisplatin and vinorelbine predicts prolonged progression-free survival — Z.G. Zimling, J.B. Sørensen, et al. (2012)
• Vinorelbine and gemcitabine as second- or third-line therapy for malignant pleural mesothelioma — M.G. Zauderer, S.L. Kass, et al. (2014)

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