Comparison of the Efficacy of First-Line Pemetrexed-Platinum and Gemcitabine-Platinum Regimens in Malignant Peritoneal Mesothelioma
Clinical Medicine Insights Oncology 2025 October 17 [Link]
Doğan Bayram, Safa Can Efil, Serap Türk, Oğuz Kara, Serhat Sekmek, Şebnem Yücel, Selin Aktürk Esen, Gökhan Uçar, Oznur Bal, Efnan Algin, Doğan Uncu
Abstract
Background: Malignant peritoneal mesothelioma (MPeM) is a rare and progressive cancer originating from the mesothelial cells of the peritoneum. In patients with early-stage disease who are suitable for surgery, the treatment of choice is CRS + HIPEC, whereas in advanced-stage patients, systemic treatments are applied. Pemetrexed plus platinum regimens are at the forefront of first-line systemic treatments. Gemcitabine plus platinum regimens are rarely used as first-line treatment for MPeM. The aim of our study is to compare the efficacy of first-line pemetrexed plus platinum with gemcitabine plus platinum regimens in patients with MPeM.
Methods: In this study, a retrospective analysis was conducted on 48 patients with MPeM who were followed up in our clinic between 2001 and 2025. In our study, 28 patients received pemetrexed plus platinum as a first-line regimen, while 20 patients received gemcitabine plus platinum. The median overall survival (OS), median progression-free survival (PFS), and response rates for both regimens were analyzed. In addition, prognostic factors influencing overall survival were investigated in the entire patient population.
Results: The median PFS and OS were 11.1 months and 17.0 months for pemetrexed and 8.01 months and 14.4 months for gemcitabine. Although pemetrexed showed numerically higher PFS and OS, the difference was not statistically significant. The objective response rate (ORR) and disease control rate (DCR) were 32.1% and 57.1% for pemetrexed, compared with 25% and 40% for gemcitabine, showing pemetrexed’s superiority in response rates. In the entire patient population, CRS + HIPEC was the main prognostic factor for survival.
Conclusion: We have demonstrated that the pemetrexed + platinum regimen has better response rates compared with the gemcitabine + platinum regimen in MPeM patients. However, gemcitabine-based regimens can be used as an alternative to pemetrexed in patients with MPeM.
