Researchers from Switzerland have reported the outcomes of 19 patients with mesothelioma scheduled to be treated with extrapleural pneumonectomy and radiation therapy after neoadjuvant chemotherapy with Gemzar® (gemcitabine) and Platinol® (cisplatin). The details of this report appeared in the September 1, 2004 issue of the Journal of Clinical Oncology .

In the recent past, standard therapy for mesothelioma was surgery and radiotherapy. However, the use of doublet chemotherapy regimens has become the standard approach, with the active agents being Alimta®, Gemzar® and Platinol® and possibly Paraplatin®. The role of neoadjuvant chemotherapy has been less well defined and there have been no randomized trials comparing surgery to no surgery for potentially operable mesothelioma. However, most patients have disease that cannot be removed with surgery.

In the current study, 19 patients were scheduled to receive neoadjuvant therapy with Gemzar® and Platinol® followed by extrapleural pneumonectomy and post-operative radiation therapy. Sixteen of the 19 patients underwent surgery and 13 patients received post-operative radiation therapy. They reported that the overall response rate to chemotherapy was 32%, with the major toxicity being thrombocytopenia. The median time to disease progression was less than 12 months and the median survival was approximately 23 months. Importantly, two patients remain alive and disease-free at 41 and 38 months after therapy.

Comments: These data suggest that neoadjuvant chemotherapy, surgery and post-operative radiation therapy are feasible in selected patients with advanced mesothelioma. However, it is not clear what role each of these components has in the management of advanced mesothelioma. It is impressive that there are two long-term survivors from this group. However, only randomized trials can determine if these three modalities are necessary for successful treatment of mesothelioma.

Reference: Weder W, Kestenholz, Taverna C, et al. Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in Malignant Mesothelioma. Journal of Clinical Oncology. 2004;22:3451-3457.