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Purpose: Patients with malignant pleural mesothelioma (MPM) are well known to have poor response to chemotherapy. The aim of this work was to evaluate the efficacy and safety of new chemotherapeutic agents for the treatment of Egyptian MPM patients. Patients and methods: The first study was a non-randomised, open-label trial. It included 34 eligible patients who were assigned to receive either cisplatin–pemetrexed or pemetrexed alone if cisplatin was contraindicated for a maximum of eight cycles. In the second trial, 21 chemo-naive patients with histologically proven advanced MPM were included. They received cisplatin and raltitrexed for a maximum of six cycles. Results: In the first trial, the median age was 43.5 years (range 25–69), partial response (PR) was achieved in 37.5%, stable disease (SD) in 50%. Median time to progression (TTP) and overall survival (OS) were 7 and 14 months, respectively. Survival at 1 year was 64.7%. No toxicity was observed in 17.6% of patients and grade 3–4 toxicity was evident in 11.8% (neutropenia), 8.8% (anaemia) and 2.9% (vomiting and diarrhoea) of patients. In the second trial, median age was 46 years (range 19–71), PR was achieved in 23.2% and one CR was reported. SD was noticed in 61.9% of patients. Median TTP and OS were 6 and 12 months, respectively. Survival at 1 year was 51.6%. Conclusion: Both cisplatin–pemetrexed and cisplatin–raltitrexed are effective and safe regimens in the treatment of MPM.

Introduc tion: Docetaxe l, Cisplatin and 5-Fluorouracil (DPF) became the standard i nduc tion c hemotherapy in advanced Head and Neck Cancer (HNC) but associated with high toxicity rate. Se veral studies reported higher response rates with better tolerability when chemotherapy dose is calculated based on Pharmacokinetics (PK) versus conventional Body Surface Area (BSA). Patien ts an d Me thods: Thirty nine patients with stage III and IV HNC who received induction DPF were inc luded in the study. Dose of cycle 1 was BSA-based then Docetaxel and 5-FU doses were PK-adjusted starting from cycle 2 whereas Cisplatin dose was BSA-based throughout the study. Results: After median follow up period of 14 months the median overall survival (OS) and progression free survival (PFS) were 15.1 and 10.6 months respectively. Twenty nine patients were available for response assessment. Seven patients (24.1%) achieved complete response while partial response encountered in 19 patients (65.5%) with and Overall response rate of 89.6%. Both treatment related side effects and mortality significantly decreased after the application of PK dose adjustments (p-value 0.007 and 0.01 respectively). Conclusi on: PK-guided dose adjustments of 5-FU and Docetaxel in D PF regimen can significantly decrease the treatment related side effects and mortality without compromising the tumor response rate. A randomized clinical trial is needed to compare the PK-guided dose adjustment with the standard BSA based protocol.

Aim: Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is the standard treatment for patients with diffuse large B-cell non-Hodgkin lymphoma (DLBCNHL). Nevertheless, anthracyclines are contraindicated for some patients, e.g. cardiac dysfunction, severe hepatic dysfunction, jaundice. Thus, this study assessed the effectiveness of non-anthracycline chemotherapy regimen cyclophosphamide, vincristine, and prednisone (CVP) in elderly DLBCNHL patients vs. the standard CHOP. Methods: This retrospective study included 418 DLBCNHL patients diagnosed between 2003 and 2006 and followed until March 2014. During this period of time, rituximab was not available for all patients, particularly for patients older than 60 years. Results: CHOP and CVP were administered to 351 (84%) and 67 (16%) patients, respectively. Older age and comorbidities, particularly cardiovascular and diabetes mellitus, were independent determinants for not receiving CHOP. Patients received more courses of CHOP treatment than that of CVP (6 vs. 3 courses; P < 0.001) and developed more toxicities (48.4% vs. 23.9%; P < 0.001), particularly fatigue, alopecia, and gastrointestinal tract toxicities. Complete response rate was higher in CHOP than in CVP (69.9% vs. 29.9%; P < 0.001). Moreover, early death was signifi cantly higher in CVP group of patients than in CHOP (43.3% vs. 8.6%; P < 0.001). After a median follow-up of 71 months, the median overall survival (OS) and event-free survival (EFS) were signifi cantly better in CHOP than in CVP (49.5 vs. 3.7 months and 32.2 vs. 3.5 months; P < 0.001 for both, respectively). Older age, poor age-adjusted International Prognostic Index scores, not receiving CHOP or consolidative radiotherapy were independent predictors of poor OS and EFS. Conclusion: Use of the CVP regime to treat DLBCNHL patients who were unfi t to the standard CHOP treatment was associated with lower remission rates and poorer EFS and OS in this group of patients.

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