Alimta and cisplatin for mesothelioma – pro

Most patients with malignant mesothelioma are candidates for systemic chemotherapy during the course of their disease, but no standard regimen has been established. Several phase II single-agent and combination chemotherapy studies have been performed over the past two decades. There are tow studies of the gemcitabine/ oxaliplatin combination to my knowledge, a retropsective revieew and two phase II studies, with small numbers of patients.  Although the true impact of chemotherapy in mesothelioma remains to be determined, agents with consistent antitumor activity include the platinum agents and the antifolates.  Recent data from a large randomized phase III clinical trial established the superiority of cisplatin/pemetrexed compared to cisplatin alone. This trial included 187 patients who were treated with either Alimta or Alimta/cisplatin and were directly compared.

Anticancer responses were achieved in 32.5% of patients treated with Alimta/cisplatin compared with 5.5% for patients treated with Alimta alone.
Anticancer responses plus disease stabilization (disease control rate) was achieved in nearly 69% of patients treated with Alimta/cisplatin, and 47% for those treated with Alimta alone.
Half of the patients were alive at 7.6 months among those treated with Alimta/cisplatin, compared with 4.1 months for those treated with Alimta alone.
Serious side effects were generally rare, with dehydration and nausea being the most common.
The researchers concluded that treatment with Alimta/cisplatin or Alimta alone produces anticancer benefits among patients with recurrent mesothelioma. The combination of Alimta/cisplatin appeared to provide greater activity than Alimta alone; however, both treatment options may be considered for this challenging disease. The combined regimen and Alimta alone are FDA approved for mesothelioma.

Pasi A. Jänne First-Line Chemotherapy for Malignant Pleural Mesothelioma in
Malignant Mesothelioma
Advances in Pathogenesis, Diagnosis, and Translational Therapies , 2006
ed. Harvey I. Pass, Nicholas J. Vogelzang and Michele Carbone

M. S. Boyar, M. Hesdorffer, R. N. Taub Phase II trial of oxaliplatin and gemcitabine in patients with malignant pleural or peritoneal mesotheliomaJournal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: 17133

Janne P, Wozniak A, Belani C, et al. Pemetrexed Alone or in Combination with Cisplatin in Previously Treated Malignant Pleural Mesothelioma: Outcomes from a Phase IIIB Expanded Access Program. Journal of Thoracic Oncology. 2006; 1: 506-512.

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