Chemotherapy in malignant pleural mesothelioma
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.
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.