At the 12th World Conference on Lung Cancer in September, 2007 there were two studies presented on the treatment of malignant mesothelioma with Alimta (pemetrexed).
All chemotherapy for mesothelioma is palliative. Therefore, identification of a chemotherapy regimen that can improve quality of life or survival is essential for improving care in this population. The most active agents for the treatment of mesothelioma include: Platinol® (cisplatin), Paraplatin® (carboplatin), Alimta, Tomudex® (raltitrexed) and Gemzar® (gemcitabine).
Patients with malignant mesothelioma are usually treated with a two drug regimen. According to results recently presented at the 2007 annual meeting of the American Society of Clinical Oncology, the combination Alimta plus Platinol or Paraplatin was more active than Platinol alone.[i] Researchers affiliated with the European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Group and the National Cancer Institute of Canada have reported that the combination of Tomudex and Platinol improves survival of patients with malignant pleural mesothelioma compared to Platinol alone.[ii]
At the World Lung Cancer Conference researchers from Germany presented the results of a open-label study of Alimta alone, Alimta with Platinol or Alimta with Paraplatin for treatment of chemonaive patients with malignant pleural mesothelioma.[iii] The following table summarizes the main findings of this study.
| Alimta | Alimta/Platinol | Alimta/Paraplatin |
| 319 | 843 | 861 |
Response | 10.5% | 26.3% | 21.7% |
Disease Control Rate | 59.1% | 77.7% | 75.8% |
1 Year Survival | 58.6% | 63.1% | 64.0% |
Median TTP | 6 months | 7 months | 7 months |
These authors concluded that all three arms had similar one year survivals although responses were higher when Alimta was given with Platinol or Paraplatin. However, previous randomized trials have found survival benefits from two drug Alimta combinations. This suggests patient selection bias in this non-randomized study.
Researchers from the Netherlands presented safety data on 988 patients with previously treated malignant pleural mesothelioma treated on an open-label study of Alimta with or without a platinum compound.[iv] These authors suggest that previously treated patients can benefit from treatment with Alimta alone, Alimta with Platinol or Alimta with Paraplatin.
Comments: These data, taken together, suggest that Alimta-Platinum combinations may be the best first choice for palliative treatment of patients with advanced malignant mesothelioma.
References:
[i]Santoro A, et al. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaive patients with malignant pleural mesothelioma: results for the international expanded access program. Proceedings from the 2007 annual meeting of the American Society of Clinical Oncology Conference. Chicago, IL. Abstract # 7562.
[ii]Van Meerbeeck JP, Gaafar R, Manegold C, et al. Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Reserch and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada.Journal of Clinical Oncology. 2005;23:6881-6889.
[iii] Manegold C, Santoro A, O’Brien ME, et al. Open-label study of pemetrexed alone or in combination with a platinum in chemonaive patients (pts) with malignant pleural mesothelioma (MPM): results from the International Expanded Access Program (EAP). Journal of Thoracic Surgery 2007;2:S602, abstract C5-01.
[iv] Gatzemeier U, Taylor P, von Pawel J, et al. Open-label study of pemetrexed alone or in combination with a platinum for previously treated patients (pts) with malignant pleural mesothelioma (MPM): Outcomes form the International Access Program (EAP). Journal of Thoracic Surgery 2007;2:S372, abstract C5-03.
Related News:
Alimta®/Platinum-compound Combination Confirmed Active in Mesothelioma (6/28/2007)
Tomudex® Plus Platinol® Improves Survival of Patients with Malignant Pleural Mesothelioma (10/3/2005)
Alimta® Approved for Mesothelioma (2/5/2004)
Pemexetred (Altima®) plus Platinol® Extends Survival in Mesothelioma: First Therapy to Make a Difference (7/14/2003)
Pemetrexed (Alimta®) Plus Platinol® Proposed as Standard of Care for Patients with Metastatic Mesothelioma (5/23/2002)
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