Significant Clinical Benefit of Pemetrexed-based Chemotherapy for Advanced Diffuse Malignant Peritoneal Mesothelioma: A Case Presentation

Our plain-English summary of Significant Clinical Benefit of Pemetrexed-based Chemotherapy for Advanced Diffuse Malignant Peritoneal Mesothelioma: A Case Presentation, by M. Peitl, S. Seiwerth, M. Bašić-Koretić, et al (Indian Journal of Medical and Paediatric Oncology, 2017).

The study

• Authors: M. Peitl, S. Seiwerth, M. Bašić-Koretić, F. Šantek
• Journal: Indian Journal of Medical and Paediatric Oncology
• Published: 2017;38(1):73-77
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is generally an understudied disease, largely because most molecular and clinical studies of mesothelioma have been conducted in patients with the more common malignant pleural mesothelioma. We present the case of a 45-year-old male that initially presented with abdominal discomfort and ascites. Diagnostic workup revealed advanced DMPM. Bimodal treatment was stared with cytoreductive surgery and hyperthermic intraperitoneal perfusion with chemotherapy procedure, followed by pemetrexed systemic monotherapy. After the disease progression, and because of a very good previous treatment response to pemetrexed, we decided to rechallenge systemic pemetrexed, along with the introduction of cisplatin. Although the intent behind systemic treatment was at first solely palliative, overall survival after the initial diagnosis was 50 months. Treatment based on rechallenging pemetrexed with or without cisplatin in patients with advanced DMPM can result in a quite satisfactory disease control and symptom management.

In plain English

This was a case report of one 45-year-old man hospitalized in September 2009 with lower abdominal pain, constipation and fluid in the abdomen (ascites). Tests showed diffuse malignant peritoneal mesothelioma of the epithelioid type. The patient denied any previous exposure to asbestos. He had incomplete cytoreductive surgery with heated chemotherapy (mitomycin C) circulated through the abdomen. About five months later, the cancer had spread to the front of the chest and to the spleen. Six cycles of pemetrexed alone gave a complete response of the chest lesion (mediastinum) and a partial response of the lesion on the spleen's surface. Twelve months later the disease progressed. He then received eight cycles of pemetrexed again, now with cisplatin. Side effects included grade 2 to 3 neutropenia and anemia. After this, the chest disease stayed stable and the abdominal lesions partly shrank. A scan in October 2013 showed further abdominal progression, and care became supportive only. The authors reported that he lived more than 50 months after diagnosis. They concluded that giving pemetrexed again, with or without cisplatin, can give satisfactory disease control in advanced cases.

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 (one patient)
• Who was studied: One 45-year-old male patient hospitalized in September 2009 and treated at the authors' institution (Department of Oncology, University Hospital Centre Zagreb, Croatia)
• Exposure: No asbestos exposure was reported: the patient denied any previous exposure to asbestos. The article studies treatment: cytoreductive surgery with HIPEC (mitomycin C 40 mg/m2), then pemetrexed 500 mg/m2 alone, and later pemetrexed 500 mg/m2 with cisplatin 75 mg/m2
• Main results:
  • Tissue findings were consistent with diffuse malignant peritoneal monomorphic epithelioid mesothelioma
  • About 5 months after surgery, a lesion in the anterior mediastinum was strongly suggestive of metastatic peritoneal mesothelioma, confirming spread into the chest
  • After six cycles of pemetrexed alone, the mediastinal lesion showed a complete response and the nodal lesion at the base of the spleen showed a partial response
  • The disease progressed 12 months after first-line chemotherapy
  • The main side effects of pemetrexed plus cisplatin were grade 2 to 3 neutropenia and grade 2 to 3 anemia, treated with supportive protocols
  • After eight cycles of pemetrexed plus cisplatin, the chest disease was stable and the abdominal and pelvic lesions partially regressed
  • A scan 6 months after second-line chemotherapy (October 2013) showed further progression of the abdominal lesions. The patient declined gemcitabine and carboplatin, and care moved to best supportive care
  • Time to progression from first- to second-line chemotherapy was 12 months, and overall survival after re-treatment was 7 months
  • The patient lived more than 50 months after the initial diagnosis
• The authors' conclusion: The authors concluded that treatment based on rechallenging pemetrexed with or without cisplatin in advanced DMPM can result in quite satisfactory disease control and symptom management. They also stressed that complete recovery or cure was never considered a reasonable expectation in this case.

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Chemotherapy, Peritoneal Mesothelioma, Mesothelioma, Pleural Mesothelioma, Ascites, Cytoreductive Surgery, Disease Progression.

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