This Chemotherapy, Radiation & Surgery therapy was tested in pleural mesothelioma patients at Memorial Sloan-Kettering Cancer Center in New York in 2009. It was called tri-modal because three different treatments were combined: 1) chemotherapy; 2) surgery; and 3) radiation therapy.

The chemo used was pemetrexed plus cisplatin. That was administered first. Then patients were given an extrapleural pneumonectomy (EPP). The radiation therapy used was hemithoracic radiation.

The doctors involved in this Chemotherapy, Radiation & Surgery therapy were some of the leaders in mesothelioma treatment and research at that time and included Drs. Krug, Pass, Rusch, Kindler, Sugarbaker, Flores, Friedberg, and Vogelzang.

The researchers reported that seventy-seven patients received chemotherapy. Fifty-seven patients also had the EPP, which was completed in 54 patients. Forty of 44 patients completed the radiation therapy. The doctors stated that the median survival was 16.8 months for the total patient group, but that patients who had completed Chemotherapy, Radiation & Surgery had a median survival of 29.1.

Treatment Details
Patients: This phase 2 study of tri-modal therapy involved 77 patients with stage I, II, or III malignant pleural mesothelioma. The median age was 63, ranging from 34 to 78 years of age. There were 56 men and 21 women in this study.

Treatment: Patients were treated with the chemotherapy drugs cisplatin and pemetrexed. They also received surgery (extrapleural pneumonectomy) and radiation therapy. Of the 77 patients in this study that received chemotherapy, 57 also received surgery and 44 received radiation therapy.

Toxicity: Following chemotherapy, there were two reports of grade 4 pulmonary embolisms and one report each of grade 4 febrile neutropenia, neutropenia, and chest pain. Almost 4% of the patients experienced grade 3 or 4 neutropenia and febrile neutropenia occurred in 2.6% of patients. Grade 3 pneumonia was reported in 5.2% of patients. Following surgery, grade 3 or 4 atrial fibrillation, pain, dyspnea, anemia, and sepsis were reported. Of these, atrial fibrillation was the most common, reported in 10.5% of patients. Following radiation, two patients had gastrointestinal toxicity, one patient each had a toxicity affecting the larynx, lung, and skin.

Results: The median overall survival for all patients, regardless of how much of the therapy was completed, was 16.8 months. Among patients that received surgery, median survival was 21.9 months. Among those that also received radiation therapy, median survival was 29.1 months.

Support: This Chemotherapy, Radiation & Surgery study was supported by research funds from Eli Lilly, which markets pemetrexed as Alimta®.

Correspondence: Dr. Lee M. Krug

Survival:16.8 months
Toxicity Grade:4
Country:United States
City/State/Province:New York, NY
Hospital:Memorial Sloan-Kettering Cancer Center
Journal:Source Link

See all conventional treatment results for mesothelioma.