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'Retreatment' with Pemetrexed Doubles Survival for Peritoneal Mesothelioma Patient

A new case report has revealed that patients with recurrent peritoneal mesothelioma can live more than four years (after relapse) when treated with second-line therapy pemetrexed (trade name Alimta). In the report titled Significant clinical benefit of pemetrexed-based chemotherapy for advanced diffuse malignant peritoneal mesothelioma: A case presentation, researchers wrote:

Available scientific data support pemetrexed in combination with cisplatin as a first-line treatment option, while gemcitabine, carboplatin, and cisplatin are often considered as possible second-line treatments. Due to the fragile postoperative state of the patient and because diffuse malignant pleural mesothelioma (DMPM) was deemed advanced at the time, single-agent pemetrexed as a palliative chemotherapy was an appropriate initial approach, even though current treatment recommendations suggest pemetrexed combined with cisplatin.

Six cycles of first-line pemetrexed chemotherapy were followed by a 1-year chemotherapy-free period, as the optimal duration of chemotherapy for DMPM patients is still not established. Therefore, in this specific case of a patient with minimal burden of disease, we decided to observe for eventual disease progression. At that point, main goals were to minimize treatment toxicity and optimize patient's quality of life. After the disease progression was established, second-line chemotherapy was selected as a treatment of choice due to the satisfactory medical condition of the patient.

As we already stated, data regarding the treatment of DMPM are scarce. However, Gilani et al. published a case report following their experience in the second-line treatment of advanced DMPM where they suggested that rechallenging pemetrexed with cisplatin may be a reasonable treatment option for patients who responded to the same drugs in the first line of chemotherapy. In light of those facts, we sought a somewhat unconventional treatment approach, as we based second-line chemotherapy on rechallenging pemetrexed with the addition of cisplatin. Eight cycles of pemetrexed with cisplatin were applied, which lead to slower disease progression, prolonged overall survival, and better quality of life. Time to progression calculated from first- to second-line chemotherapy treatment was 12 months and overall survival after re-treatment was 7 months.

Despite a highly unfavorable prognosis, patient lived for more than 50 months after the initial diagnosis. Nevertheless, it needs to be stressed out that complete recovery or even cure was never considered to be a reasonable expectation. According to the available medical reports, progression-free survival and median overall survival (OS) seem to be highly variable, with median overall survival ranging from 13.1 to 92 months. Those periods seem to be influenced by the extent of disease at presentation, ability to surgically resect gross disease, gender, or intensity of treatment.

Physicians dealing with such a rare entity as DMPM have to bear in mind that the prognosis and overall survival of patients suffering from peritoneal mesothelioma has changed considerably during the last decade, even for the advanced stages, and that treatment of such patients should not only consist of symptomatic or palliative care.

If you or someone you love has been diagnosed with mesothelioma, thanks to drugs such as pemetrexed (Alimta) and cisplatin (Platinol and Platinol-AQ), and those currently in clinical trials, you do have a fighting chance. Talk to your doctor about the different types of pioneering drug combinations and leading-edge clinical trials that have the potential to save hundreds, if not thousands, of lives.

 

Sources

Peitl, Milena, Sven Seiwerth, Martina Basic-Koretic, and Fedor Santek. "Significant Clinical Benefit of Pemetrexed-based Chemotherapy for Advanced Diffuse Malignant Peritoneal Mesothelioma: A Case Presentation." Indian Journal of Medical and Paediatric Oncology 38.1 (2017): 73. Web. 16 Aug. 2017.

"Types of Mesothelioma." Cancer Research UK. Cancer Research UK, 10 Nov. 2015. Web. 16 Aug. 2017.