Chemotherapy in malignant pleural mesothelioma
Wednesday, December 21st, 2005.
Revista Portuguesa de Pneumologia. 2005 Nov-Dec;11(6 Suppl 1):14-5. [Link]
F B, N C, A M, A F.
Servico Pneumologia Centro Hospitalar de Coimbra.
Abstract
Rational and objective: During the last few years a variety of new chemotherapy agents have been used (mostly in combination) in the treatment of malignant pleural mesothelioma (MPM). Combination therapy with platinum was the mainstay therapy for late stages. Recently, combination cisplatinum/pemetrexed was approved as standard first-line treatment for MPM. The aim of this study is to review results obtained with chemotherapy in MPM.
Material and methods: We treated 16 patients in a 7-year period. From 1997 to 1999 we used a combination regimen of cisplatinum + epirubicin + cyclophosphamide (6 patients). From 2000 to 2004 we used gemcitabine + carboplatinum (8 patients) or gemcitabine + cisplatinum (2 patients).
Results: Polichemotherapy was administered to 16 patients (15 men, 1 woman) with mean age of 61.4 (44-76) years. Thirteen patients had an initial PS=0/1; ten patients had professional contact with products presumably containing asbestos; histology results identified epithelial-type in 14 patients and mixed-type in 2; all patients were in stages III or IV; diagnosis was made by VATS in 14 patients, blind pleural biopsy in 1 patient and guided transthoracic biopsy in 1 patient. Thirteen patients had palliative radiotherapy over the area submitted to specimen collection. We obtained partial responses in 4 patients (25%), stability in 6 (37.5%) and progression in 6 (37.5%). Mean number of chemotherapy sessions was 4.5. To date (September, 2005) 15 patients have died. Mean length to progression was 6.4 months (2-14) and survival 13.8 months (4-29). We observed 7 cases of neutropenia (grades 3 and 4), 2 of which were febrile neutropenia with hospital admission.
Reflection: Our results regarding this rare pathology were similar to those found in the literature. It would be interesting to collect national data from all units that treat or have treated MPM; a clinical study comparing the actual chemotherapy regimen to one of those used previously would be another interesting approach to this pathology.
Glossary
- therapy
- any of the measures taken to treat a disease. Unproven therapy is any therapy that has not been scientifically tested and approved. Use of an unproven therapy instead of standard (proven) therapy is called alternative therapy. Some alternative therapies have dangerous or even life-threatening side effects. For others, the main danger is that a patient may lose the opportunity to benefit from standard therapy. Complementary therapy, on the other hand, refers to therapies used in addition to standard therapy. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient's sense of well-being. The ACS recommends that patients considering use of any alternative or complementary therapy discuss this with their health care team.
- regimen
- (rej-uh-men) a strict, regulated plan (such as diet, exercise, or other activity) designed to reach certain goals. In cancer treatment, a plan to treat cancer.
- diagnosis
- identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.
- chemotherapy
- (key-mo-THER-uh-pee) treatment with drugs to destroy cancer cells. Chemotherapy is often used with surgery or radiation to treat cancer when the cancer has spread, when it has come back (recurred), or when there is a strong chance that it could recur.
- biopsy
- (buy-op-see) the removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from a lump. In a core biopsy, a larger needle is used to remove more tissue.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- pemetrexed
- chemotheraputic agent that interferes with a crucial process that allows cancer cells to reproduce and spread. Specifically, pemetrexed stops the production of three enzymes that are required to feed the cancer cell. Often used in combination with cisplatin. Marketed under the name ALIMTA. See: Alimta.
