Mesothelioma Chemotherapy: Study Compares Cisplatin to Carboplatin

An article recently published in the scientific journal Lung Cancer investigated the benefits and costs of substituting the established combination of cisplatin and pemetrexed with carboplatin and pemetrexed.

Chemotherapy with cisplatin and pemetrexed is one of the few chemotherapeutic options that have shown to be moderately successful for malignant pleural mesothelioma (MPM) patients; however, this combination can be quite toxic on the body. There is no cure for malignant mesothelioma and the treatments that attempt to cure the disease are considered aggressive and can be accompanied by a range of unwanted side effects.

Authors of the study note that “two randomised phase III studies have demonstrated a survival benefit in MPM with the use of antifolates such as raltitrexed or pemetrexed, when combined with cisplatin… These two studies have demonstrated an absolute improvement in median overall survival of 2.6 and 2.8 months, respectively, compared with single agent cisplatin treatment. This has led to many institutions adopting cisplatin and pemetrexed as standard first line palliative chemotherapy for MPM.”

Unfortunately, the combination of cisplatin and pemetrexed produces unwanted toxic effects and this prompted researchers to study other chemotherapy drugs to pair with pemetrexed. Researchers commented, “Recently, two phase II trials have evaluated the efficacy of carboplatin and pemetrexed in MPM. These two studies demonstrated overall response rates of 18.6 and 25%, with median survival rates of 12.7 and 14 months. Following on from these results, we have conducted a retrospective analysis of MPM patients treated with carboplatin and pemetrexed in our institution outside the context of a clinical trial.”

In an effort to find a chemotherapeutic combination with less toxicity and side effects, researchers further investigated the approach of substituting cisplatin with carboplatin when paired with pemetrexed. Using a retrospective review approach, researchers evaluated 49 cases of malignant pleural mesothelioma treated with carboplatin and pemetrexed and compared the results with established data on cisplatin paired with pemetrexed.

The disease control rate (which was defined as no signs of progression from a CT scan) for the evaluated patients was 69 percent, and partial response and stable disease percentages were 28 percent and 41 percent, respectively. Clinical improvement rate was shown in 69 percent of patients and the majority of the patients with symptomatic improvement reported the benefit after two cycles of chemotherapy. Toxicities were generally low and better than toxicities reported with cisplatin and pemetrexed.

The median time to treatment failure was 4.6 months. The median overall survival in this study was 14 months, which is comparable to the cisplatin-pemetrexed overall survival of 12.1 months. Researchers found, “In conclusion, our data would suggest the combination of carboplatin and pemetrexed may be a viable option in the treatment of MPM, especially in patients where there are anticipatory problems with the use of cisplatin.”

Additional information about mesothelioma and treatment options may be found through the Mesothelioma Center.

This entry was posted on Tuesday, January 26th, 2010 at 5:33 pm and is filed under Mesothelioma, Mesothelioma Research, Mesothelioma Treatment. You can follow any responses to this entry through the RSS feed. Responses are currently closed, but you trackback from your own site.