Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. Surgical complete resection, which is the only radical therapy available, is only possible in a minority of patients who suffer from a locally advanced disease. Radiotherapy can be considered as an adjuvant therapy after surgery or as supportive treatment in palliative care. Attempts are also made at combining it with chemotherapy. In cases of locally advanced, non-resectable or metastatic disease, chemotherapy remains the treatment of choice. The most effective palliative chemotherapy is the pemetrexed plus cisplatin regimen. We describe 3 cases of patients who underwent standard palliative chemotherapy with pemetrexed and cisplatin, manifesting good radiological and clinical response, followed by maintenance therapy with pemetrexed. The use of pemetrexed maintenance therapy helped achieve many years of disease control with acceptable toxicity. The consecutive stages of therapy were continuously discussed with our patients, and their informed consent was obtained. Pemetrexed maintenance therapy is not a standard procedure, but recent findings suggest it may be an efficacious option to consider in selected groups of patients. Further randomized prospective studies are needed, but a limiting factor is the rarity of the disease.

Aim of the studyDue to the emergence of new therapeutic opportunities in the second-line treatment of metastatic renal cell carcinoma, the choice of the appropriate medication requires consideration. Making the selection one should take into account the likelihood of response, the probability of toxicity, properties of the drug and the clinical characteristics of the patient. Aim of the work was to confirm antitumor efficacy of axitinib in patients with metastatic clear-cell renal-cell carcinoma in the second line treatment remaining under the care of our institution. The primary objective was to determine antitumor activity, secondary – to evaluate progression free survival, safety of the treatment and to analyse clinical characteristics of treated population.ResultsTreatment records of 27 patients (9 females, 18 males) treated from October 2014 to the present (July 2016) were reviewed. The median duration of treatment which corresponds to the time to disease progression in observed population was 6 months (range: under 1 month – 16 months). 1 patient (3.7%) had got objective response (PR, partial remission). Clinical benefit rate (PR + SD (stable disease) was 66%. 9 patients (33.33%) experienced treatment toxicity only in the first degree of CTCAE (common toxicity criteria for adverse events), 11 patients (40.74%) presented the second degree toxicity and 5 patients (18.5%) – third degree. The most commonly reported treatment related adverse events were diarrhea (47%), fatigue (26%), hand-foot syndrome (26%), deterioration of blood pressure control (22.2%), abnormal liver function tests (18.5%), mucositis (11.1%). We observed 3 cases of unacceptable toxicity.ConclusionsAxitinib confirms its effectiveness also in situation outside clinical trials, however, it is characterized by significant toxicity. Therefore, qualification for treatment should take into account the clinical patient characteristics. Effective diagnosis and treatment of side effects and dose optimization are the key skills of the attending physician.

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