Carboplatin and pemetrexed in the management of malignant pleural mesothelioma: A realistic treatment option?

Abstract 

Background

Malignant pleural mesothelioma is an aggressive cancer. Chemotherapy with cisplatin and pemetrexed can improve overall survival but has a toxic profile. Substitution of cisplatin with carboplatin may avoid some potential side-effects. Therefore, we undertook a retrospective review to assess the effectiveness and tolerability of carboplatin and pemetrexed in patients with malignant pleural mesothelioma in clinical practice.

Methods

Patients with malignant pleural mesothelioma who had been treated with carboplatin and pemetrexed were retrospectively identified from pharmacy databases. The endpoints were disease control rate, time to treatment failure, clinical improvement rate and overall survival. We also evaluated any significant haematological and non-haematological toxicities.

Results

A total of 49 patients were identified. Of 45 evaluable cases, the disease control rate was achieved in 34 patients (69%, 95% CI 55–82, intention to treat analysis). The clinical response rate was achieved in 34 out of 49 patients (69%, 95% CI 55–82). The median time to treatment failure was 4.6 months (95% CI 3.4–5.8) and median overall survival was 14 months (95% CI 9.5–18.5). Grade 3/4 haematological toxicities were observed in 7 patients (14.3%). Grade 3/4 non-haematological toxicities were seen in 12 patients (24.5%). No toxic deaths were recorded.

Conclusion

The combination of carboplatin and pemetrexed may be a viable option in the treatment of malignant pleural mesothelioma.

Abbreviations: CI, confidence interval, MPM, malignant pleural mesothelioma, IMIG, International Mesothelioma Interest Group, AUC, area under the curve, i.v., intravenous, DCR, disease control rate, CT, computed tomography, TTF, time to treatment failure, OS, overall survival

Keywords: Pleural, Mesothelioma, Pemetrexed, Carboplatin, Chemotherapy, Disease control, Retrospective, Survival