Retreatment with pemetrexed-based chemotherapy in patients with malignant pleural mesothelioma

Ceresoli, Giovanni Luca; Zucali, Paolo Andrea; Vincenzo, Fabio De; Gianoncelli, Letizia; Simonelli, Matteo; Lorenzi, Elena; Ripa, C.; Giordano, Laura; Santoro, Armando

doi:10.1016/j.lungcan.2010.12.004

Cited by 121 publications

(82 citation statements)

References 25 publications

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“…First line treatment was pemetrexed plus carboplatin in 27 or plus cisplatin in 4 patients (10). Eighteen patients received the rechallenge in second line of treatment and the remaining subsequently after treatment with vinorelbine or gemcitabine.…”

Section: Rechallenge With Pemetrexedmentioning

confidence: 99%

Medical treatment of malignant pleural mesothelioma relapses

et al. 2018

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Pattern of mesothelioma relapsesPatients with resectable mesothelioma can benefit from multimodality treatments that can include induction chemotherapy plus extrapleural pneumonectomy and then post-operative radiotherapy or pleurectomy decortication followed by chemotherapy. The first approach has significantly higher perioperative mortality and complications (1). Patterns of relapse are different between the two techniques. After pleurectomy decortication, local relapses are more frequent including progressions in homolateral chest and pericardium. After extrapleural pneumonectomy, progressions in distant sites were more common including contralateral lung/pleural, lymph nodes and peritoneum (2). However, extrapleural pneumonectomy also local recurrences have been reported with or without concomitant distant metastases in 31% and 46% of completely resected tumors, respectively (3). In the MARS trial, that compare extrapleural pneumonectomy with less invasive approaches, the progression free survival (PFS) was 7.6 and 9 months, respectively (4).Unresectable patients benefit from chemotherapy, being the standard of care the combination of pemetrexed and cisplatin. In a phase III trial, 226 and 222 chemotherapy naïve mesothelioma patients were randomly assigned to receive cisplatin with or without pemetrexed, respectively (5). The combination increased survival compared with cisplatin alone: 12.1 vs. 9.3 months (P=0.002). Similarly, time to progression was longer in the combination arm: 5.7 vs. 3.9 months (P=0.001).The French Cooperative Thoracic Intergroup conducted a phase III trial to compare the first line treatment with cisplatin-pemetrexed with or without the addiction of bevacizumab (6). Two hundred and twenty-three and 225 patients were randomly assigned to receive treatment with or without bevacizumab, respectively. The group treated with bevacizumab obtained an increased overall survival (OS) compared to the control arm (median OS 18.8 vs. 16.1 months, respectively; hazard ratio 0.77; P=0.0167). Similarly, an increase of PFS was observed with bevacizumab (median 9.2 vs. 7.3 months; P<0.0001). A higher rate of bevacizumab related side effects were observed in the experimental arm:

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Section: Rechallenge With Pemetrexedmentioning

confidence: 99%

Medical treatment of malignant pleural mesothelioma relapses

et al. 2018

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“…It was recently demonstrated that PBC may be used as rechallenge treatment in MPM patients who achieve a PFS ≥12 months with first-line PBC (4)(5)(6). We have also noticed in clinical practice that certain patients with non-squamous NSCLC benefited from rechallenge with PBC as second-or further-line treatment.…”

Section: Introductionmentioning

confidence: 87%

Rechallenge with pemetrexed-based chemotherapy improves the survival of patients with advanced non-squamous non-small-cell lung cancer

Zhuo

Bai

Wang

et al. 2014

Molecular and Clinical Oncology

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Abstract. Rechallenge chemotherapy with pemetrexed was shown to be efficient in malignant pleural mesothelioma; however, its role in non-small-cell lung cancer (NSCLC) has not been investigated. In this study, we retrospectively enrolled 31 patients with non-squamous NSCLC who had achieved disease control with initial pemetrexed treatment, followed by rechallenge with pemetrexed-based chemotherapy (PBC) upon disease progression. After the rechallenge, 5 patients (16.1%) achieved partial remission (PR), 17 (54.8%) achieved stable disease (SD) and 9 (29.1%) experienced progressive disease. The treatment was generally well tolerated, with a low rate of toxicity. The median progression-free survival (PFS) was 3.8 months with the rechallenge. Patients with a PFS of ≥10 months with initial PBC exhibited longer PFS and overall survival (OS) with the rechallenge compared to those with a PFS of <10 months with initial PBC (PFS: 6.2±0.33 vs. 3.1±0.26 months, respectively; P= 0.011; and OS, 19.8±3.2 vs. 9.2±1.1 months, respectively; P=0.005). The time from the termination of initial PBC to disease progression was also associated with survival after the rechallenge. However, the response to initial PBC (PR vs. SD) did not affect PFS after the rechallenge. No significant differences were observed in thymidylate synthase expression, echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase gene fusion, or epithelial growth factor receptor mutation status between pemetrexed-sensitive and pemetrexed-resistant patients. Our results demonstrated that rechallenge with PBC was well tolerated and survival after the rechallenge was associated with survival during initial PBC. Therefore, patients with a PFS of ≥10 months or time-to-disease progression ≥3 months may be considered as candidates for pemetrexed rechallenge.

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“…Cancer and Leukemia Group B is conducting a randomized phase II trial (CALGB 30901) of pemetrexed versus observation for MPM patients without progression after first-line pemetrexed plus platinum chemotherapy and hopefully will clarify the role of maintenance pemetrexed. Table 3 summarizes the current evidence for second-line (and beyond) chemotherapy [64][65][66][67][68].…”

Section: Cytotoxic Therapymentioning

confidence: 99%

Current Issues in Malignant Pleural Mesothelioma Evaluation and Management

Stevenson

2014

The Oncologist

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Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e‐P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e‐P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer.

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Retreatment with pemetrexed-based chemotherapy in patients with malignant pleural mesothelioma

Cited by 121 publications

References 25 publications

Medical treatment of malignant pleural mesothelioma relapses

Medical treatment of malignant pleural mesothelioma relapses

Rechallenge with pemetrexed-based chemotherapy improves the survival of patients with advanced non-squamous non-small-cell lung cancer

Current Issues in Malignant Pleural Mesothelioma Evaluation and Management

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