A phase II study evaluating the cisplatin and epirubicin combination in patients with unresectable malignant pleural mesothelioma

Lung Cancer. Volume 50, Issue 1, October 2005, Pages 75-82. Available online June 13, 2005. [Link]

T. Berghmans^a, J.J. Lafitte^b, M. Paesmans^c, B. Stach^d, M.C. Berchier^e, P. Wackenier^f, J. Lecomte^g, T. Collon^h, P. Mommenⁱ, J.P. Sculier^a and For the European Lung Cancer Working Party (ELCWP)¹

^aDepartment of Intensive Care and Thoracic Oncology, Institut Jules Bordet, Rue H�ger-Bordet 1, 1000 Bruxelles, Belgium
^bDepartment of Pneumology, CHU Calmette, Lille, France
^cData Centre, Institut Jules Bordet, Brussels, Belgium
^dDepartment of Pneumology, Cabinet M�dical Dampierre, Anzin, France
^eDepartment of Pneumology, Hôpital d’Hayange, Hayange, France
^fDepartment of Pneumology, Hôpital Ambroise Par�, Mons, Belgium
^gDepartment of Pneumology, CHU Charleroi, Charleroi, Belgium
^hDepartment of Pneumology, CHI le Raincy-Montfermeil, Montfermeil, France
ⁱData Centre, ELCWP, Brussels, Belgium

Abstract

Few chemotherapeutic agents have demonstrated their efficacy in malignant mesothelioma. The cisplatin plus doxorubicin combination has one of the highest response rates. Epirubicin is an anthracyclin, analogous to doxorubicin, with a different toxicologic pattern. As there are no data on the activity of the combination cisplatin plus epirubicin in malignant mesothelioma, the European Lung Cancer Working Party (ELCWP) designed a phase II study with response rate as primary objective.

Sixty-nine eligible patients with malignant pleural mesothelioma were centrally registered. The majority of the patients were male (n = 59), had a Karnofsky performance status of 80 or more (n = 62) and presented with an epithelial histologic subtype (n = 43). Median age was 62 years. In nine patients, metastases were documented at the initial work-up, mainly in bone, lung and skin. Three hundred and twenty-four cycles of chemotherapy were administered. The main toxicities were nausea and vomiting, neutropenia and alopecia. Among 63 assessable patients, response rate was 19.0% (95% confidence interval [CI] 9–29%). Median survival was 13.3 months. In multivariate analysis, poor prognostic factors for survival were neutrophil count and CALGB groups 4–6.

In conclusion, cisplatin plus epirubicin appears as an effective regimen in malignant mesothelioma, with a favourable toxicity profile. However, it does not demonstrate superior activity to other active regimens in this disease.