Significant clinical benefit of pemetrexed-based chemotherapy for advanced diffuse malignant peritoneal mesothelioma: A case presentation

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is generally an understudied disease, largely because most molecular and clinical studies of mesothelioma have been conducted in patients with the more common malignant pleural mesothelioma. We present the case of a 45-year-old male that initially presented with abdominal discomfort and ascites. Diagnostic workup revealed advanced DMPM. Bimodal treatment was stared with cytoreductive surgery and hyperthermic intraperitoneal perfusion with chemotherapy procedure, followed by pemetrexed systemic monotherapy. After the disease progression, and because of a very good previous treatment response to pemetrexed, we decided to rechallenge systemic pemetrexed, along with the introduction of cisplatin. Although the intent behind systemic treatment was at first solely palliative, overall survival after the initial diagnosis was 50 months. Treatment based on rechallenging pemetrexed with or without cisplatin in patients with advanced DMPM can result in a quite satisfactory disease control and symptom management.

Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure

“…Surgical cytoreduction of peritoneal mesothelioma tumours lead to a fivefold increase in overall survival time, although reportedly only 40% of patients with this diagnosis elect to undergo surgery 15. A systemic first-line treatment option, pemetrexed has halted the disease progression for up to 12 months in cases of diffuse malignant peritoneal mesothelioma, with follow-up therapy of cisplatin along with a second round of pemetrexed showing stability of the intrathoracic malignancy for an additional 6 months 16. Cytoreduction along with heated intraperitoneal chemotherapy is shown to have the best outlook for survival duration, with the median survival ranging from 34 to 92 months, with nuclear size being the dominant determining factor of survival time in patients 5 13 17–19…”