"Researchers affiliated with the European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Group and the National Cancer Institute of Canada have reported that the combination of Tomudex (raltitrexed) and Platinol (cisplatin) improves survival of patients with malignant pleural mesothelioma (MPM) compared to Platinol alone. The details of this randomized phase III trial were reported in the October 1, 2005, issue of the Journal of Clinical Oncology.

Malignant pleural mesothelioma is a rare cancer caused by chronic exposure to asbestos. Patients with this disease often have a decreased quality of life from symptoms caused by the cancer, such as shortness of breath, cough, pain, fatigue, and the inability to eat. This type of cancer is resistant to most therapies, which consist of surgery, chemotherapy, and/or radiation therapy. Furthermore, most people do not learn they have malignant pleural mesothelioma until the disease has progressed to an advanced stage when treatment with surgery or radiation is not an option. Therefore, identification of a chemotherapy regimen that can improve quality of life or survival is essential for improving care in this population."

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Q&A: Latest Treatments for Mesothelioma

Researchers are studying whether chemotherapy before surgery and radiation can deter tumor recurrence in patients with mesothelioma, a rare cancer of the lining of the chest caused by asbestos exposure. 

The study builds on the success of a previous clinical trial at M. D. Anderson that included surgery called extra pleural pneumonectomy (EPP), which involves removal of the affected lung and lining of the chest, followed by a highly specialized form of radiation therapy known as Intensity Modulated Radiotherapy (IMRT).

The new multi-center study, which will recruit 77 patients nationwide, will involve EPP, post-operative IMRT and the chemotherapy drugs pemetrexed (Alimta®) and cisplatin, says Katherine Pisters, M.D., principal investigator on the study at M. D. Anderson and associate professor in the Department of Thoracic/Head and Neck Medical Oncology.

The other trial locations are:

• Memorial Sloan-Kettering Cancer Center, New York
• University of Chicago, Chicago
• Johns Hopkins Hospital, Baltimore
• Barbara Ann Karmanos Cancer Institute, Detroit
• University of Pennsylvania, Philadelphia
• Brigham and Women’s University, Boston

Many of the sites already have begun studying the use of chemotherapy prior to surgery and radiation. The chemotherapy combination of pemetrexed and cisplatin was approved by the Food and Drug Administration (FDA) for treatment of mesothelioma after the drugs were shown to prolong survival. 

Answering questions about both studies are Pisters, Craig Stevens, M.D., Ph.D., principal investigator on the previous M. D. Anderson trial and associate professor in the Division of Radiation Oncology; and David Rice, M.D., surgical principal investigator on the new study and assistant professor in the Department of Thoracic and Cardiovascular Surgery.

What is unique about this study?

Pisters: This is the first mesothelioma trial to explore the use of chemotherapy before surgery and radiation.

How does the new trial build on the previous study?

Stevens: Our previous trial involving extrapleural pneumonectomy and IMRT was more than 90% effective in preventing a local recurrence (return of the cancer to its original site). However, 50% of those patients experienced recurrence in a different location, usually the other lung, abdomen or another part of the body. M. D. Anderson will be the only center employing IMRT rather than conventional radiation therapy.

Pisters: We are now adding chemotherapy before surgery and radiation to decrease the possibility of distant cancer metastasis (spread to an area away from the original site). We are using pemetrexed and cisplatin because they already have been shown to be effective in metastatic disease.

Read the Entire Articles and Mesothelioma Questions & Answers section at Cancer Wise.org, click here.


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