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Case Report Reveals 4-Plus Year Survival After 'Retreatment' with Pemetrexed

It is often noted that the average life expectancy for mesothelioma patients is 12 to 21 months after diagnosis. Studies show that around 40 percent of patients live just one year and 20 percent live more than two years. Now, a new case report has revealed that patients with recurrent peritoneal mesothelioma can live more than four years (after relapse) when treated with second-line therapy pemetrexed (trade name Alimta).  

Peritoneal mesothelioma is one of the two main types of mesothelioma. This type of mesothelioma grows in the tissue lining the inside of the tummy (abdomen). This is called the peritoneum. The other main type of mesothelioma is pleural mesothelioma. It is more common than peritoneal mesothelioma and starts in the sheets of tissue that cover the lungs. These are called the pleura. Because peritoneal is less common, researchers say it is generally an understudied disease. With the spotlight on the new case report titled Significant clinical benefit of pemetrexed-based chemotherapy for advanced diffuse malignant peritoneal mesothelioma: A case presentation, the medical community and mesothelioma patients alike have high hopes that more studies will follow.

In the case study, a team of researchers, including head researcher Dr. Milena Peitl, wrote:

In a not so distant past, patients such as presented here would be considered preterminal and therefore treated only palliatively and supportively, with quite a short life expectancy. Nowadays, treatment of choice for complete cytoreduction is CRS/HIPEC. On the other hand, guidelines for systemic therapy are not that straightforward. Available scientific data support pemetrexed in combination with cisplatin as a first-line treatment option, while gemcitabine, carboplatin, and cisplatin are often considered as possible second-line treatments. Due to the fragile postoperative state of the patient and because diffuse malignant pleural mesothelioma (DMPM) was deemed advanced at the time, single-agent pemetrexed as a palliative chemotherapy was an appropriate initial approach, even though current treatment recommendations suggest pemetrexed combined with cisplatin.

Six cycles of first-line pemetrexed chemotherapy were followed by a 1-year chemotherapy-free period, as the optimal duration of chemotherapy for DMPM patients is still not established. Therefore, in this specific case of a patient with minimal burden of disease, we decided to observe for eventual disease progression. At that point, main goals were to minimize treatment toxicity and optimize patient's quality of life. After the disease progression was established, second-line chemotherapy was selected as a treatment of choice due to the satisfactory medical condition of the patient.

As we already stated, data regarding the treatment of DMPM are scarce. However, Gilani et al. published a case report following their experience in the second-line treatment of advanced DMPM where they suggested that rechallenging pemetrexed with cisplatin may be a reasonable treatment option for patients who responded to the same drugs in the first line of chemotherapy. In light of those facts, we sought a somewhat unconventional treatment approach, as we based second-line chemotherapy on rechallenging pemetrexed with the addition of cisplatin. Eight cycles of pemetrexed with cisplatin were applied, which lead to slower disease progression, prolonged overall survival, and better quality of life. Time to progression calculated from first- to second-line chemotherapy treatment was 12 months and overall survival after re-treatment was 7 months.

Despite a highly unfavorable prognosis, patient lived for more than 50 months after the initial diagnosis. Nevertheless, it needs to be stressed out that complete recovery or even cure was never considered to be a reasonable expectation. According to the available medical reports, progression-free survival and median overall survival (OS) seem to be highly variable, with median overall survival ranging from 13.1 to 92 months. Those periods seem to be influenced by the extent of disease at presentation, ability to surgically resect gross disease, gender, or intensity of treatment.

Physicians dealing with such a rare entity as DMPM have to bear in mind that the prognosis and overall survival of patients suffering from peritoneal mesothelioma has changed considerably during the last decade, even for the advanced stages, and that treatment of such patients should not only consist of symptomatic or palliative care 

If you or someone you love has been diagnosed with mesothelioma, there is hope. Thanks to both FDA approved drugs such as pemetrexed (Alimta) and cisplatin (Platinol and Platinol-AQ), and those currently in clinical trials, those diagnosed with mesothelioma do have a fighting chance. Talk to your doctor about the different types of innovative drug combinations and groundbreaking clinical trials that have the potential to save thousands of lives.

 

Sources

Peitl, Milena, Sven Seiwerth, Martina Basic-Koretic, and Fedor Santek. "Significant Clinical Benefit of Pemetrexed-based Chemotherapy for Advanced Diffuse Malignant Peritoneal Mesothelioma: A Case Presentation." Indian Journal of Medical and Paediatric Oncology 38.1 (2017): 73. Web. 16 Aug. 2017.

"Types of Mesothelioma." Cancer Research UK. Cancer Research UK, 10 Nov. 2015. Web. 16 Aug. 2017.