Radiology Medical News about malignant pleural mesothelioma;neoadjuvant Premetrexed plus Cisplatin; extrapleural pneumonectomy;radiation

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Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma
Journal of Clinical Oncology, 06/24/09

Krug LM et al. - In a study to assess the use of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy (EPP) and hemithoracic radiation (RT) in stage I to III malignant pleural mesothelioma, it was shown that trimodality therapy is feasible with a reasonable long-term survival rate, particularly for pts who completed all therapy. Radiologic response to chemotherapy, but not sex, histology, disease stage, or nodal status, was associated with improved survival.

Methods

Requirements included stage T1-3 N0-2 disease, no prior surgical resection, adequate organ function (including predicted postoperative forced expiratory volume in 1 sec 35%), and performance status 0 to 1.
Pts received pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 for 4 cycles.
Pts without disease progression underwent EPP followed by RT (54 Gy).
The primary endpoint was pathologic complete response (pCR) rate.

Results

77 pts received chemotherapy.
All 4 cycles were administered to 83% of pts.
Radiologic response rate was 32.5%.
57 pts proceeded to EPP, which was completed in 54 pts.
3 pCRs were observed (5% of EPP).
40 of 44 pts completed irradiation.
Median survival in the overall population was 16.8 mos.
Pnts completing all therapy had a median survival of 29.1 mos and a 2-yr survival rate of 61.2%.
Radiologic response of complete or partial response was associated with median survival of 26.0 mos vs 13.9 mos for pts with stable disease or progressive disease.

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