Opting for the stronger chemotherapy drug Cisplatin instead of the more physically tolerable Carboplatin – which happen much of the time today – is not always the best option for mesothelioma cancer patients, according to a recent study in Italy.
Doctors advising their patients should take a closer look at the “tolerability factor,” and the more severe side effects of Cisplatin, according to researchers at the Oncologic Venetian Institute in Padua, Italy, who did the study.
“Our study suggests that a `gentler,’ approach could be better as neoadjuvant chemotherapy of MPM (malignant pleural mesothelioma),” they concluded in a report published last month in Anticancer Research.
Pleural mesothelioma, which has no cure, is caused by an exposure to asbestos fibers. An estimated 3,000 people are diagnosed with mesothelioma annually in the United States. And the best course of treatment remains debatable.
The most popular therapy regimen today is a multi-modality approach that includes both surgery and a combination of chemotherapy drugs. Pemetrexed, which is sold under the brand name of Alimta, is most often combined with either Cisplatin or Carboplatin.
Many doctors and patients looking for the most aggressive treatment available opt for Cisplatin, but they might be subjecting themselves to unnecessary and severe side effects, according to the study.
“Patients who received Cisplatin struggle to complete the trimodality protocol without complications,” lead researcher Giulia Pasello told Asbestos.com earlier this month. “Our paper suggests a possible role for Carboplatin because of the long and hard road the patients go through.”
Pasello and his peers studied 51 mesothelioma patients since 2005 at the Venetian Institute, all of which underwent surgery and were treated with a chemotherapy combination. Of those, 27 were treated with a regimen that included Carboplatin and 24 with Cisplatin.
They found that the response, progression-free survival, disease control and resection rate in the two treatment groups were similar, offering no advantage to those getting Cisplatin, which also produced a consistently higher toxicity profile.
They also found, and were not surprised by, more severe side effects that caused a debilitating effect with Cisplatin, particularly among the more elderly patients. The lower tolerability to Cisplatin impaired the clinical condition of patients undergoing surgery.
He thought the better clinical condition was imperative for those who were undergoing the more aggressive extrapleural pneumonectomy (EPP) surgery.
“I surely think that Carboplatin should be preferred to Cisplatin in some patients,” Pasello said. “(They) showed a better tolerability, and similar efficacy of Carboplatin compared to Cisplatin in the neoadjuvant setting.”
The toxicity profiles of the patients showed a higher incidence of Grade 3 anaemia in the Cisplatin patients. Grade 2 nausea, vomiting and asthenia were also more common in patients treated with Cisplatin. They found neurotoxicity in one patient treated with Cisplatin and none with the Carboplatin patients.
The milder side effects of Carboplatin led to an increased number of patients (74 percent to 67 percent) being able to finish the entire protocol, compared to those taking the Cisplatin.
“We observed a trend toward a longer overall survival in the (Carboplatin group) compared to the (Cisplatin group) for the subgroup of elderly patients (greater than 70),” the report stated.
Pasello also said that a much-larger patient sampling would be needed before making any blanket and definitive conclusion on the best possible chemotherapy regimen.