Diffuse Pleural Mesothelioma - Pemetrexed - Cisplatin
Conclusion
With rates of objective tumour regression ranging from 10 to 30% for cytotoxic monotherapy, diffuse pleural mesothelioma was considered to date to be widely chemoresistant. The most favourable responses to conventional chemotherapeutic agents were reported by the antimetabolites methotrexate and edatrexate.
In the past few years, a number of novel cytotoxic agents have been introduced into clinical oncology, the activity of which has also been tested in Malignant Pleural Mesothelioma (MPM) therapy. Initial results produced by monotherapy based on new antimetabolites, along with platin combinations, provide encouragement. Preliminary results of the raltitrexed-oxaliplatin combination have shown promising activity. Single-agent gemcitabine and the drug combined with cisplatin appear to decrease symptoms associated with tumor load. In particular, pemetrexed with cisplatin has demonstrated superior median overall survival, response rate, lung function and quality-of-life measures in the largest randomised trial in Malignant Pleural Mesothelioma (MPM). These promising data suggest that finally effective chemotherapy exists for this aggressive disease and that pemetrexed-cisplatin will become a new systemic therapy standard.