Abstract
Background: The role of second-line chemotherapy (SLC) is not yet established in malignant pleural mesothelioma (MPM) but SLC is being used increasingly in our experience because many patients are still fit at the time of disease progression.
Methods: In this retrospective study, we reviewed our experience of SLC in pemetrexed-pretreated patients with MPM at two French thoracic oncology units (Institut Gustave Roussy, Villejuif; Hôpital Percy, Clamart).
Results: Between January 2005 and December 2006, 84 consecutive patients with MPM who progressed after pemetrexed-chemotherapy were enrolled. Forty-four patients (52,3%) received a SLC. There were 30 men and 14 women. The median age was 58 years (range, 34-76). Most patients had a PS ≤ 1 (82%) and an epithelial histologic subtype (91%). The median time to progression (TTP) after first-line chemotherapy was 6,1 months. The SLC was a pemetrexed therapy in 21 patients (with a relapse more than 3 months), and a new regime in 20 patients (gemcitabine alone or with oxaliplatin). The other 3 patients were enrolled in a phase I study. According to RECIST criteria, a partial response was observed in 7 patients and 9 patients had stable disease after SLC. The median TTP after SLC was 3,8 months. The median survival was 12,2 months (range: 2 to 72 months). Four of these 44 patients then received third-line (4,8%) and two received fourth-line therapy (2,4%).
Conclusions: Our experience suggests the feasibility of giving SLC to patients with MPM who are healthy at the time of disease progression. The optimal treatment has not been defined to date and prospective trials are needed in this setting.
- © 2011 ERS