Tuberc Respir Dis.  2007 May;62(5):432-436.

Dramatic Tumor Response to 2nd-line Pemetrexed/Cisplatin Combination Chemotherapy in Patient with Malignant Pleural Mesothelioma.

• Lee SM
• Ko SY
• Seo TH
• Lee JH
• Choi SO
• Lee JG
• Kim WS
• Lee TH
• Yoo GH
• Lee KY

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumor that is difficult to clearly distinguish from an adenocarcinoma but usually has a poor prognosis. Numerous cytotoxic agents have been used in the primary treatment of MPM with limited success. A complete response is unusual and a partial response occurs in less than one-third of patients. Recently, a phase III trial showed that a combination of pemetrexed with cisplatin resulted in a significantly higher response rate and median survival time than with cisplatin alone. We encountered a case of a dramatic tumor response to pemetrexed/cisplatin combination chemotherapy in patients with MPM, which was resistant to the 1st-line gemcitabine/cisplatin therapy. After six cycles of pemetrexed/cisplatin combination chemotherapy, the tumor volume had decreased dramatically with complete symptom relief. There was no chemotherapy-related toxicity or scheduled violation. The patient is under maintenance chemotherapy with the same regimen.

Keyword

Malignant pleural mesothelioma; Pemetrexed; Cisplatin

MeSH Terms

Adenocarcinoma
Cisplatin
Cytotoxins
Drug Therapy, Combination*
Humans
Maintenance Chemotherapy
Mesothelioma*
Prognosis
Tumor Burden
Pemetrexed
Cisplatin
Cytotoxins

Figure

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  Figure 1 The initial chest PA shows right side massive pleural mass with effusion.

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  Figure 2 A) The tumor shows epithelioid mesothelioma with tubulopapillary pattern. The cells lining the tubules and papillae are cuboidal and relatively bland (H&E, ×200). B) Mesothelioma showing strong nuclear and cytoplasmic positivity for calretinin (Calretinin stain, ×200).

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  Figure 3 The following chest CT scan shows tumor progression after first line chemotherapy with gemcitabine/cisplatin. Large soft tissue mass of right pleura with multifocal loculated effusion compress lung parenchyma. No remarkable mediastinal lymph node enlargement is seen.

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  Figure 4 The following chest CT scan shows that the pleural mass of rind with effusion was resolved dramatically after combination chemotherapy with pemetrexed/cisplatin.

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