Abstract
Background
Malignant pleural mesothelioma (MPM) is an aggressive neoplasm that responds poorly to chemotherapy. Although treatment with pemetrexed in combination with cisplatin serves as first-line chemotherapy for MPM, the optimal second-line and beyond therapy has not yet been fully examined.
Methods
Between March 2008 and October 2011, 17 consecutive Japanese patients pretreated with at least one regimen of platinum plus pemetrexed chemotherapy received gemcitabine and vinorelbine. Responses, survival time, and toxicity were retrospectively evaluated.
Results
Response [partial response (PR) + complete response (CR)] and disease control [stable disease (SD) + PR + CR] rates were 18 and 82 %, respectively. The median progression-free survival (PFS) after combination chemotherapy was 6.0 months, whereas the median overall survival (OS) was 11.2 months. Grade 3 or 4 neutropenia and anemia were observed in 41 and 29 % of patients, respectively, and one patient experienced febrile neutropenia. Grade 3 or 4 nonhematologic toxicities included constipation (6 %) and phlebitis (6 %).
Conclusion
Combination chemotherapy using gemcitabine with vinorelbine was shown to have moderate activity in Japanese MPM patients pretreated with platinum plus pemetrexed chemotherapy. A further multicenter phase II trial is warranted to confirm the efficacy and safety of this combination treatment.
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Acknowledgments
We thank Ms. Yumiko Oshima for reviewing the patient charts, and Dr. Brian T. Quinn for critical comments on the manuscript.
Conflict of interest
Drs. Hirai, Shiraishi, Yamaguchi, Seto and Ichinose have financial relationships with Eli Lilly Japan and Kyowa Hakko Kirin Co., Ltd., and other authors have no conflict of interest to declare.
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Toyokawa, G., Takenoyama, M., Hirai, F. et al. Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy. Int J Clin Oncol 19, 601–606 (2014). https://doi.org/10.1007/s10147-013-0619-5
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DOI: https://doi.org/10.1007/s10147-013-0619-5