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Published on: February 12, 2017
First-line chemotherapy with pemetrexed plus cisplatin for malignant peritoneal mesothelioma
Eriko Fujimoto1, Takashi Kijima1, Kozo Kuribayashi1
1a Division of Respiratory Medicine, Department of Internal Medicine , Hyogo College of Medicine , Hyogo , Japan.
Background:
Mesothelioma of peritoneal origin has wider variation in treatment outcomes than mesothelioma of pleural origin, likely because peritoneal mesothelioma comprises borderline malignant variants and aggressive malignant peritoneal mesothelioma (MPeM). This study retrospectively evaluates the efficacy of first-line systemic pemetrexed and cisplatin chemotherapy in MPeM.
Research Design And Methods:
Twenty-four patients with histologically proven MPeM were treated with pemetrexed plus cisplatin as a first-line systemic chemotherapy. The response was evaluated radiologically according to standard Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Twenty-two patients underwent 18F-fluorodeoxyglucose positron emission tomography/(FDG-PET)/computed tomography(CT) at baseline, and 13 were eligible for metabolic assessment.
Results:
Two complete responses and 9 partial responses were achieved. Overall response rate and disease control rate were 45.8% and 91.7%, respectively. Median progression-free survival and median overall survival were 11.0 months and 15.8 months, respectively. Wet- type MPeM had significantly longer survival (40.9 months median) than other clinical types (15.5 months) (P = 0.045). The baseline maximum standardized uptake value in 22 patients was 8.93 (range, 2.5-16.77).
Conclusions:
Systemic pemetrexed plus cisplatin is active for MPeM. Disparity with the outcome of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) needs to receive more emphasis, since peritoneal mesothelioma has a 5-year survival rate of 50%.
Insights
First-line chemotherapy with pemetrexed and cisplatin shows significant activity in aggressive malignant peritoneal mesothelioma (MPeM). This treatment offers a high disease control rate and notable survival benefits, particularly for the wet-type MPeM.
Area of Science:
- Oncology
- Medical Research
Background:
- Peritoneal mesothelioma exhibits varied treatment outcomes due to the presence of both borderline and aggressive malignant variants.
- Aggressive malignant peritoneal mesothelioma (MPeM) requires distinct therapeutic strategies compared to pleural mesothelioma.
Purpose of the Study:
- To evaluate the efficacy of first-line systemic chemotherapy using pemetrexed and cisplatin in patients with aggressive malignant peritoneal mesothelioma (MPeM).
Main Methods:
- Retrospective analysis of 24 patients with histologically confirmed MPeM treated with pemetrexed plus cisplatin.
- Tumor response assessed using Response Evaluation Criteria In Solid Tumors (RECIST) criteria.
- 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) used for baseline metabolic assessment in a subset of patients.
Main Results:
- An overall response rate of 45.8% and a disease control rate of 91.7% were observed.
- Median progression-free survival was 11.0 months, and median overall survival was 15.8 months.
- Wet-type MPeM demonstrated significantly longer survival (median 40.9 months) compared to other clinical types (median 15.5 months).
Conclusions:
- Systemic pemetrexed plus cisplatin chemotherapy is an active treatment for aggressive malignant peritoneal mesothelioma (MPeM).
- The effectiveness of this chemotherapy warrants further emphasis, especially when compared to cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), given the 5-year survival rates for peritoneal mesothelioma.
