Co-existing pericardial and pleural malignant mesothelioma responding well to nedaplatin and pemetrexed: a case report

Our plain-English summary of Co-existing pericardial and pleural malignant mesothelioma responding well to nedaplatin and pemetrexed: a case report, by M. Wu, Z. Li, J. Cai, et al (AME Case Reports, 2023).

The study

• Authors: M. Wu, Z. Li, J. Cai, X. Zhong, W. Zheng, S. Wu, M. Lin, Q. Zhang
• Journal: AME Case Reports
• Published: 2023;7:32
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma (MM) is a rare cancer with poor prognosis. It is less common that two serosal cavities are involved when the patient seeks medical attention firstly. The current first-line chemotherapy for advanced MM is a combination with cisplatin and pemetrexed. However, nedaplatin, a second-generation platinum-based antitumor agent, has the similar therapeutic effects as cisplatin but lower toxicity and higher water solubility. To our knowledge, this is the first case of co-existing pericardial and pleural MM treated with nedaplatin and pemetrexed and responding well.

Case Description: A 33-year-old woman, who had worked in a kiln for more than 10 years, suffered from dyspnea and chest tightness for 6 days. Chest computed tomography (CT) showed a massive pericardial effusion. She was diagnosed tuberculous pericarditis and received 6 months antituberculosis treatment (rifampicin, isoniazide, pyrazinamide, ethambutol). But it was ineffective and she was re hospitalized again due to massive pleural effusion and pericardial effusion. She was diagnosed with co-existing pericardial and pleural MM finally based on pleural biopsy and cytology of pericardial effusion. She was responding well excitedly to chemotherapy with nedaplatin and pemetrexed with high tolerance. Bone marrow toxicity or recurrent massive pericardial or pleural effusion were not observed during chemotherapy. However, she gave up chemotherapy and has survived for 22 months, from the onset symptoms.

Conclusions: In terms of clinical tolerance and less adverse reactions, we suggest that chemotherapy of nedaplatin with pemetrexed may be a more appropriate treatment in advanced MM. Further clinical trials are warrant.

2023 AME Case Reports. All rights reserved.

In plain English

This was a case report from Shantou Central Hospital, China, about one 33-year-old woman who had worked in a kiln for more than 10 years. The authors described this as a history of occupational asbestos exposure but gave no fiber type or measurements. In March 2020 she was admitted with breathlessness, chest tightness and a large fluid build-up around the heart, and she was treated for suspected tuberculous pericarditis for 6 months. In September 2020 she returned with large fluid build-ups around both the heart and lungs. A pleural biopsy and pericardial fluid cytology led to a diagnosis of malignant mesothelioma of the pericardium and pleura. After 8 cycles of nedaplatin with pemetrexed, her symptoms eased, with no bone marrow toxicity or recurrent massive effusion. During pemetrexed-only maintenance, pleural thickening and fluid increased. She stopped chemotherapy for financial reasons and died in December 2021, 22 months after symptoms began. The authors suggested this drug combination may be a more appropriate treatment for advanced mesothelioma but said clinical trials are needed. They noted that no pericardial tissue was obtained.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One previously healthy 33-year-old woman, first admitted to the Department of Cardiology at Shantou Central Hospital, China, in March 2020
• Exposure: More than 10 years of work in a kiln, which the authors took as a history of occupational asbestos exposure. No fiber type, product or dose was reported.
• Main results:
  • She was first treated for suspected tuberculous pericarditis with 6 months of antituberculosis drugs.
  • After readmission in September 2020, malignant mesothelioma of the pericardium and pleura was diagnosed from pleural biopsy and pericardial fluid cytology.
  • After 8 cycles of pemetrexed and nedaplatin over 6 months, her cough, expectoration, breathlessness and chest tightness eased.
  • During this chemotherapy, no bone marrow toxicity and no recurrent massive pericardial or pleural effusion were seen.
  • Pleural thickening and pleural or pericardial fluid increased after 3 cycles of pemetrexed-only maintenance therapy.
  • She stopped chemotherapy in August 2021 because of financial hardship and died at home in December 2021, a survival of 22 months from the onset of symptoms.
• The authors' conclusion: The authors suggested that nedaplatin with pemetrexed may be a more appropriate treatment in advanced malignant mesothelioma, given its tolerance and fewer adverse reactions. They said further clinical trials are needed because this is only a case report.
• Limitations the authors state:
  • No pericardial tissue was obtained because the patient declined a pericardial biopsy as too risky.
  • It could not be determined whether the pleural or the pericardial tumor was the primary one.
  • It is a single case report, so trials are needed to assess efficacy, safety and dosing.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Mesothelioma, Pemetrexed (Alimta), Prognosis, Chemotherapy, Cisplatin, Dyspnea, Pericardial Effusion.

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