First-line chemotherapy with pemetrexed plus cisplatin for malignant peritoneal mesothelioma

ABSTRACT

Background: Mesothelioma of peritoneal origin has wider variation in treatment outcomes than mesothelioma of pleural origin, likely because peritoneal mesothelioma comprises borderline malignant variants and aggressive malignant peritoneal mesothelioma (MPeM). This study retrospectively evaluates the efficacy of first-line systemic pemetrexed and cisplatin chemotherapy in MPeM.

Research design and methods: Twenty-four patients with histologically proven MPeM were treated with pemetrexed plus cisplatin as a first-line systemic chemotherapy. The response was evaluated radiologically according to standard Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Twenty-two patients underwent ¹⁸F-fluorodeoxyglucose positron emission tomography/(FDG-PET)/computed tomography(CT) at baseline, and 13 were eligible for metabolic assessment.

Results: Two complete responses and 9 partial responses were achieved. Overall response rate and disease control rate were 45.8% and 91.7%, respectively. Median progression-free survival and median overall survival were 11.0 months and 15.8 months, respectively. Wet- type MPeM had significantly longer survival (40.9 months median) than other clinical types (15.5 months) (P = 0.045). The baseline maximum standardized uptake value in 22 patients was 8.93 (range, 2.5–16.77).

Conclusions: Systemic pemetrexed plus cisplatin is active for MPeM. Disparity with the outcome of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) needs to receive more emphasis, since peritoneal mesothelioma has a 5-year survival rate of 50%.

KEYWORDS:

• Asbestos
• cisplatin
• malignant peritoneal mesothelioma
• Wet type
• FDG-PET:
• metabolic response
• pemetrexed

Acknowledgments

We thank the medical staff of our institution, Dr. Miki Honda, Dr. Taiichiro Otsuki, Dr. Daisuke Horio, Dr. Yuichi Koda, Dr. Yumiko Akano, Dr. Tomoko Nakamura, and Dr. Hirotoshi Ishigaki, for their contributions to this study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work was supported by MEXT-supported Program for the Strategic Research Foundation at Private Universities (2012-2016), and in part by Sendai Kousei Hospital Research Funding (2011).