Pemetrexed plus carboplatin in elderly patients with malignant pleural mesothelioma: combined analysis of two phase II trials

Abstract

The incidence of malignant pleural mesothelioma (MPM) in elderly patients is increasing. In this study, pooled data from two phase II trials of pemetrexed and carboplatin (PC) as first-line therapy were retrospectively analysed for comparisons between age groups. Patients received pemetrexed 500 mg m À2 and carboplatin AUC 5 mg ml À1 min À1 intravenously every 21 days with standard vitamin supplementation. Elderly patients were defined as those X70 years old. A total of 178 patients with an ECOG performance status of p2 were included. Median age was 65 years (range 38 -79), with 48 patients X70 years (27%). Grade 3 -4 haematological toxicity was slightly worse in X70 vs o70-year-old patients, with neutropenia observed in 25.0 vs 13.8% (P ¼ 0.11), anaemia in 20.8 vs 6.9% (P ¼ 0.01) and thrombocytopenia in 14.6 vs 8.5% (P ¼ 0.26). Non-haematological toxicity was mild and similar in the two groups. No significant difference was observed in terms of overall disease control (60.4 vs 66.9%, P ¼ 0.47), time to progression (7.2 vs 7.5 months, P ¼ 0.42) and survival (10.7 vs 13.9 months, P ¼ 0.12). Apart from slightly worse haematological toxicity, there was no significant difference in outcome or toxicity between age groups. The PC regimen is effective and well tolerated in selected elderly patients with MPM.

Chemotherapy treatment in malignant pleural mesothelioma: a difficult history

“…7 m o n t h s , r e s p e c t i v e l y ( 2 4 ) . Furthermore, a secondary combined analysis of two of these trials found that this combination was well tolerated and had a similar level of activity in elderly patients (≥70 years), compared with younger ones (26). These results are similar to those with the cisplatin-based combination.…”

Thymidylate Synthase and Excision Repair Cross-Complementing Group-1 as Predictors of Responsiveness in Mesothelioma Patients Treated with Pemetrexed/Carboplatin

“…In our study, we retrospectively evaluated whether the expression of ERCC1 or TS and their main functional polymorphisms could predict clinical outcome in a homogeneous population of 99 MPM patients treated with the carboplatin/pemetrexed regimen described in our previous studies (7,8).…”

“…Many patients with MPM are unfit to receive the cisplatin-based chemotherapy due to the increasing incidence of the disease in the elderly population and the poor performance status often observed at onset. Pemetrexed alone (6) or combined with carboplatin (7,8) has been proposed as alternative treatment choices for these patients.…”

Malignant pleural mesothelioma: an update on diagnosis and treatment options

“…Irrespective of the lack of randomized evidence, carboplatin is often substituted for cisplatin due to simpler administration and perceived lower toxicity. There have been no direct phase III comparisons between the two platinum agents, although phase I and II studies have shown similar activity and similar objective radiological response rates of either in combination with pemetrexed [Ceresoli et al 2006[Ceresoli et al , 2008. Patients are often offered carboplatin in the setting of medical contraindications to cisplatin.…”