PEMETREXED RETREATMENT FOR MESOTHELIOMA MAY BE HELPFUL

NEW YORK (Reuters Health) Jan 20 - Retreatment with pemetrexed can prolong survival in some patients with malignant pleural mesothelioma (MPM), researchers from Italy report online in Lung Cancer online January 8th.
Pemetrexed (Alimta) is a folate antimetabolite.
"There is a subgroup of patients with advanced MPM who can achieve a prolonged survival advantage from pemetrexed-based chemotherapy," Dr. Giovanni L. Ceresoli from Cliniche Humanitas Gavazenni, Bergamo, told Reuters Health in an email. "In this subgroup of patients (that we can estimate to be about 15-20% of all patients who are candidates for first-line pemetrexed-based chemotherapy), rechallenge with the same regimen is the best available strategy."
Dr. Ceresoli and colleagues investigated the effects of retreatment with pemetrexed-based chemotherapy in 122 MPM patients who progressed after first-line pemetrexed-based chemotherapy. Of these, 68 received a second-line treatment with different regimens, and 36 had best supportive care only.
Of the 31 patients retreated with pemetrexed-based chemotherapy (15 with pemetrexed alone, 16 with a pemetrexed/platinum combination), one experienced a complete response and five achieved a partial response, for an objective response rate of 19%. Nine patients (29%) had stable disease, and the remaining 16 patients (52%) had progressive disease.
Median progression-free survival was 3.8 months, and median overall survival was 10.5 months. One-year estimated progression-free survival was higher for those receiving pemetrexed-based chemotherapy as second-line (13.3%) than for those receiving pemetrexed retreatment later (0%), and 1-year overall survival followed the same pattern (51.6% with second-line retreatment, 16.7% with later retreatment).
Retreatment with pemetrexed was generally well tolerated, and few dose reductions were required.
"Pemetrexed-based chemotherapy is the treatment of choice for patients with malignant pleural mesothelioma (MPM)," Dr. Ceresoli explained. "It should be considered in every patient with this disease who is fit enough to receive chemotherapy. Pemetrexed-based chemotherapy has a role also in multimodality protocols, including surgery and radiotherapy, for the few patients who are diagnosed in an early stage and are candidates for surgical resection. Finally, elderly patients should not be excluded from treatment with pemetrexed, even though they should be carefully evaluated to avoid unnecessary toxicities."
"We have recently concluded a phase II trial of the combination of pemetrexed and carboplatin plus bevacizumab, an anti-angiogenic compound," Dr. Ceresoli said. "The results of this trial, together those of other similar studies, will clarify the role (if any) of anti-angiogenic strategies in MPM. We have also planned a prospective validation of the results of our study on retreatment published on Lung Cancer, and a study on elderly patients including a multi-dimensional geriatric assessment."
Lung Cancer. Posted online January 8, 2011. Abstract