Pemetrexed (A)/platinum for patients with advanced malignant peritoneal mesothelioma (AbM)—The Bielefeld experience

An international expanded access program was initiated to provide access to treatment with pemetrexed prior registration and reimbursement for malignant mesothelioma (MM). Chemonaïve and pretreated patients with inoperable MM of the pleura or peritoneum were eligible. This report describes the results obtained in German centers. Investigators could choose between three treatments: Pemetrexed 500 mg/m(2) alone (P) or in combination with cisplatin 75 mg/m(2) (PC) or carboplatin AUC 5 (PCb). From November 2002 to June 2004, a total of 567 patients (554 with pleural MM; 41% pretreated) were included. Of 548 evaluable patients with pleural MM, 191 received P, 137 PC and 220 PCb. Patients in the P group were more often pretreated (70%) and had worse performance status compared with the other groups. In the P, PC, and PCb groups overall response rate (ORR) was 16%, 24% and 18%, median time to progression (TTP) was 5.5, 8.2, and 6.9 months, and median overall survival (OS) was 8.7, 11.3 and 9.7 months respectively. Efficacy outcomes were better for chemonaïve than for pretreated patients, and P was less hematotoxic than PC or PCb. Treatment of pleural MM with pemetrexed alone or in combination with platinum was safe and active as first and second-line therapy.

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“…Preliminary evidence suggests that pemetrexed-based chemotherapy has similar activity in peritoneal mesothelioma. 17…”

Section: Discussionmentioning

confidence: 99%

“…Survival of patients with peritoneal mesothelioma seemed to be longer; results for this subgroup of patients have been presented in part elsewhere. 17…”

Section: Efficacymentioning

confidence: 99%

Pemetrexed in the treatment of malignant mesothelioma: Results from an expanded access program in Germany

Reck

Stahel

Pawel

et al. 2010

Respiratory Medicine

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“…Mean time to progression was 11.5 months, and mean overall survival was 13.7 months. 29 In a tiny series typical of MPeM studies, Greek investigators treated six patients with MPeM with pemetrexed/ cisplatin. All had undergone an exploratory laparotomy during which a cytoreductive surgery was attempted, but none had a complete cytoreduction.…”

Section: Systemic Chemotherapymentioning

confidence: 99%

Peritoneal Mesothelioma: The Site of Origin Matters

Kindler¹

2013

American Society of Clinical Oncology Educational Book

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The etiology, gender distribution, pathology, natural history, and treatment options for mesothelioma (MM) differ substantially depending on the site of origin. Peritoneal mesothelioma (MPeM) is a rare disease, comprising only approximately 10% to 15% of the 2,500 cases of MM diagnosed in the United States each year. Patients with MPeM are younger than patients with pleural MM, and a higher proportion, mostly women, are long-term survivors. Most MPeM is caused by asbestos exposure. Germ-line mutations of BAP1 (BRCA associated protein 1) can predispose to MM, uveal melanoma, and potentially other cancers. MPeM can be challenging to diagnose, and cytology is rarely helpful. Review by an experienced pathologist using a panel of at least two positive and two negative immunohistochemical stains is essential. The three major pathologic subtypes are epithelial, sarcomatoid, and biphasic. Most cases are epithelial; the others have a dismal prognosis. Two indolent subtypes of borderline malignant potential-well-differentiated papillary mesothelioma and benign multicystic mesothelioma-are more common in the peritoneum and are treated surgically. In highly selected patients receiving treatment at experienced referral centers, an aggressive locoregional strategy that combines cytoreductive surgery to remove all gross disease and hyperthermic intraperitoneal chemotherapy to treat residual microscopic tumors yields a 3-year survival of 60% and a median survival approaching 5 years, far better than expected from historic controls. This approach also provides durable palliation of malignant ascites in nearly all patients. Pemetrexed is the only U.S. Food and Drug Administration (FDA)-approved systemic chemotherapy for pleural MM. Largely on the basis of data from pharmaceutical registry studies, the activity of pemetrexed-based chemotherapy appears to be similar in pleural MM and MPeM.

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Malignant peritoneal mesothelioma—Results from the International Expanded Access Program using pemetrexed alone or in combination with a platinum agent

Cartenì¹,

Manegold²,

García³

et al. 2009

Lung Cancer

117

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Pemetrexed (A)/platinum for patients with advanced malignant peritoneal mesothelioma (AbM)—The Bielefeld experience

Cited by 5 publications

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Pemetrexed in the treatment of malignant mesothelioma: Results from an expanded access program in Germany

Pemetrexed in the treatment of malignant mesothelioma: Results from an expanded access program in Germany

Peritoneal Mesothelioma: The Site of Origin Matters

Malignant peritoneal mesothelioma—Results from the International Expanded Access Program using pemetrexed alone or in combination with a platinum agent

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