Researchers involved in a multi-center U.S. trial have reported neoadjuvant chemotherapy with Alimta® (pemetrexed) and Platinol® (cisplatin), followed by pneumonectomy and radiation therapy, may improve survival of patients with Stage I-III pleural malignant mesothelioma. The details of this study appeared in the June 20, 2009 issue of the Journal of Clinical Oncology.[1]

Patients with Stage I-III malignant pleural mesothelioma have cancer limited to one side of the chest. In these cases it may be possible to remove the cancer surgically. However, in Stage III disease, there can be extensive local spread. This spread may include the regional lymph nodes, lungs, and soft tissues, but there is no spread to the opposite lung.

The lack of any single consistently curative treatment modality for patients with Stage I-III malignant pleural mesothelioma has led to the development of multi-modality therapy, which may include surgery, radiation therapy, and/or chemotherapy. Current research suggests that patients in good condition with Stage I-III malignant pleural mesothelioma should be treated with adjuvant chemotherapy and radiation therapy following surgery. However, not all patients will be eligible for multi-modality treatment. Surgery for Stage I-III pleural mesothelioma consists of pleurectomy (decortication) or extrapleual pneumonectomy. Patients with epithelial type Stage I-III pleural mesothelioma treated with surgery and adjuvant chemoradiotherapy have an approximate two-year survival of 60% or more.

The current study evaluated trimodality therapy with neoadjuvant Alimta and Platinol followed by extrapleural pneumonedtomy and adjuvant radiotherapy in 77 patients with Stage I-III malignant pleural mesothelioma. Patients included those with and without positive lymph nodes. Prior to surgery the success rate of delivering four cycles of chemotherapy was 83%. The response rate to chemotherapy was 32.5%, which was determined radiologically. Fifty-seven patients proceeded to surgery, which was completed in 54 patients. Three patients had a pathological CR at the time of surgery. Forty of 44 patients completed radiotherapy. Median survival for the entire group of patients was 17 months. Patients completing all therapy had a two-year survival of 61%. Radiological response to chemotherapy was associated with an improved survival. These authors conclude that this approach produced reasonable long-term survival.

Comments: This trimodality approach to treating patients with Stage I-III pleural mesothelioma produces results similar to those previously reported for the same approach with adjuvant rather than neoadjuvant chemotherapy. It would take a randomize trial to determine if the results of this trial were better than previously reported.  

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