Treatment of Malignant Peritoneal Mesothelioma

A large multi-institutional registry study evaluated cytoreductive surgery combined with HIPEC in patients with diffuse, malignant, peritoneal mesothelioma.[19] Among 401 patients, 187 (46%) had complete or near-complete cytoreduction, and 372 (92%) received HIPEC. Of the patients who received HIPEC, 311 (83%) received cisplatin and doxorubicin. The median follow-up period was 33 months (range, 1–235 months).

A large multi-institutional registry study evaluated cytoreductive surgery combined with HIPEC in patients with diffuse, malignant, peritoneal mesothelioma.[19] Among 401 patients, 187 (46%) had complete or near-complete cytoreduction, and 372 (92%) received HIPEC. Of the patients who received HIPEC, 311 (83%) received cisplatin and doxorubicin. The median follow-up period was 33 months (range, 1–235 months).

Grade 3 to 4 complications occurred in 127 of 401 patients (31%), and 9 patients (2%) died perioperatively.

A large multi-institutional registry study evaluated cytoreductive surgery combined with HIPEC in patients with diffuse, malignant, peritoneal mesothelioma.[19] Among 401 patients, 187 (46%) had complete or near-complete cytoreduction, and 372 (92%) received HIPEC. Of the patients who received HIPEC, 311 (83%) received cisplatin and doxorubicin. The median follow-up period was 33 months (range, 1–235 months).

The median actuarial OS was 53 months, with survival rates of 81% at 1 year, 60% at 3 years, and 47% at 5 years.

A large multi-institutional registry study evaluated cytoreductive surgery combined with HIPEC in patients with diffuse, malignant, peritoneal mesothelioma.[19] Among 401 patients, 187 (46%) had complete or near-complete cytoreduction, and 372 (92%) received HIPEC. Of the patients who received HIPEC, 311 (83%) received cisplatin and doxorubicin. The median follow-up period was 33 months (range, 1–235 months).

Prognostic factors associated with improved survival on multivariate analysis included epithelioid histological subtype, absence of lymph node metastases, complete or near complete resection, and the use of HIPEC.

A second multi-institutional report included 211 patients treated at three centers in the United States (who were not part of the previous study).[20] All patients underwent cytoreductive surgery and HIPEC using either cisplatin or mitomycin. In patients with malignant peritoneal mesothelioma, the efficacy of pemetrexed plus cisplatin appeared comparable with that seen in patients with pleural mesothelioma, and the regimen was well tolerated. Prospective phase II or III clinical trials of this regimen have not been conducted in patients with peritoneal mesothelioma.

A second multi-institutional report included 211 patients treated at three centers in the United States (who were not part of the previous study).[20] All patients underwent cytoreductive surgery and HIPEC using either cisplatin or mitomycin. In patients with malignant peritoneal mesothelioma, the efficacy of pemetrexed plus cisplatin appeared comparable with that seen in patients with pleural mesothelioma, and the regimen was well tolerated. Prospective phase II or III clinical trials of this regimen have not been conducted in patients with peritoneal mesothelioma.

The actuarial OS was 38 months. The survival rates were 41% at 5 years and 26% at 10 years.

A second multi-institutional report included 211 patients treated at three centers in the United States (who were not part of the previous study).[20] All patients underwent cytoreductive surgery and HIPEC using either cisplatin or mitomycin. In patients with malignant peritoneal mesothelioma, the efficacy of pemetrexed plus cisplatin appeared comparable with that seen in patients with pleural mesothelioma, and the regimen was well tolerated. Prospective phase II or III clinical trials of this regimen have not been conducted in patients with peritoneal mesothelioma.

Prognostic factors associated with improved survival were age younger than 60 years, complete or near-complete gross resection, low versus high histological grade, and the use of cisplatin versus mitomycin.

In the U.S. Pemetrexed Expanded Access Program, 98 patients (9.3%) had peritoneal mesothelioma, 57 patients were previously treated, and 38 patients were chemotherapy-naive.[21] Of the 73 patients with malignant peritoneal mesothelioma and measurable disease, 28 patients were chemotherapy-naive and 43 patients were previously treated. Twenty-six patients received single-agent pemetrexed, and 47 patients received pemetrexed and cisplatin. Carboplatin may be substituted for cisplatin.

In the U.S. Pemetrexed Expanded Access Program, 98 patients (9.3%) had peritoneal mesothelioma, 57 patients were previously treated, and 38 patients were chemotherapy-naive.[21] Of the 73 patients with malignant peritoneal mesothelioma and measurable disease, 28 patients were chemotherapy-naive and 43 patients were previously treated. Twenty-six patients received single-agent pemetrexed, and 47 patients received pemetrexed and cisplatin. Carboplatin may be substituted for cisplatin.

The overall response rate was 26%. Similar objective response rates were achieved in previously treated and chemotherapy-naive patients.

In the U.S. Pemetrexed Expanded Access Program, 98 patients (9.3%) had peritoneal mesothelioma, 57 patients were previously treated, and 38 patients were chemotherapy-naive.[21] Of the 73 patients with malignant peritoneal mesothelioma and measurable disease, 28 patients were chemotherapy-naive and 43 patients were previously treated. Twenty-six patients received single-agent pemetrexed, and 47 patients received pemetrexed and cisplatin. Carboplatin may be substituted for cisplatin.

The median OS for previously treated patients was 13.1 months; it had not been reached at the time of the analysis for chemotherapy-naive patients.

In the U.S. Pemetrexed Expanded Access Program, 98 patients (9.3%) had peritoneal mesothelioma, 57 patients were previously treated, and 38 patients were chemotherapy-naive.[21] Of the 73 patients with malignant peritoneal mesothelioma and measurable disease, 28 patients were chemotherapy-naive and 43 patients were previously treated. Twenty-six patients received single-agent pemetrexed, and 47 patients received pemetrexed and cisplatin. Carboplatin may be substituted for cisplatin.

As expected, both response rate (29% vs. 19%) and median survival (13.1 vs. 8.7 months) were higher for patients who received the pemetrexed doublet than for those who received pemetrexed alone in this nonrandomized study.

In the U.S. Pemetrexed Expanded Access Program, 98 patients (9.3%) had peritoneal mesothelioma, 57 patients were previously treated, and 38 patients were chemotherapy-naive.[21] Of the 73 patients with malignant peritoneal mesothelioma and measurable disease, 28 patients were chemotherapy-naive and 43 patients were previously treated. Twenty-six patients received single-agent pemetrexed, and 47 patients received pemetrexed and cisplatin. Carboplatin may be substituted for cisplatin.

These results were comparable with those seen in pleural mesothelioma.

In the International Pemetrexed Expanded Access Program, 29 evaluable patients with peritoneal mesothelioma received pemetrexed 500 mg/m2 and carboplatin, dosed at an area under the curve of 5.[22]

In the International Pemetrexed Expanded Access Program, 29 evaluable patients with peritoneal mesothelioma received pemetrexed 500 mg/m2 and carboplatin, dosed at an area under the curve of 5.[22]

Seven patients (24%) had objective responses (one complete), and 52% had stable disease.

In the International Pemetrexed Expanded Access Program, 29 evaluable patients with peritoneal mesothelioma received pemetrexed 500 mg/m2 and carboplatin, dosed at an area under the curve of 5.[22]

These results were comparable with those achieved with pemetrexed and cisplatin.