Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma Journal Article

   

Authors:	Krug, L. M.; Pass, H. I.; Rusch, V. W.; Kindler, H. L.; Sugarbaker, D. J.; Rosenzweig, K. E.; Flores, R.; Friedberg, J. S.; Pisters, K.; Monberg, M.; Obasaju, C. K.; Vogelzang, N. J.
Article Title:	Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma
Abstract:	Purpose Neoadjuvant pemetrexed plus cisplatin was administered, followed by extrapleural pneumonectomy (EPP) and hemithoracic radiation (RT), to assess the feasibility and efficacy of trimodality therapy in stage I to III malignant pleural mesothelioma. Patients and Methods Requirements included stage T1-3 N0-2 disease, no prior surgical resection, adequate organ function (including predicted postoperative forced expiratory volume in 1 second >= 35%), and performance status 0 to 1. Patients received pemetrexed 500 mg/m(2) plus cisplatin 75 mg/m(2) for four cycles. Patients without disease progression underwent EPP followed by RT (54 Gy). The primary end point was pathologic complete response (pCR) rate. Results Seventy-seven patients received chemotherapy. All four cycles were administered to 83% of patients. The radiologic response rate was 32.5% (95% CI, 22.2 to 44.1). Fifty-seven patients proceeded to EPP, which was completed in 54 patients. Three pCRs were observed (5% of EPP). Forty of 44 patients completed irradiation. Median survival in the overall population was 16.8 months (95% CI, 13.6 to 23.2 months; censorship, 33.8%). Patients completing all therapy had a median survival of 29.1 months and a 2-year survival rate of 61.2%. Radiologic response of complete or partial response was associated with a median survival of 26.0 months compared with 13.9 months for patients with stable disease or progressive disease (P = .05). Conclusion This multicenter trial showed that trimodality therapy with neoadjuvant pemetrexed plus cisplatin is feasible with a reasonable long-term survival rate, particularly for patients who completed all therapy. Radiologic response to chemotherapy, but not sex, histology, disease stage, or nodal status, was associated with improved survival. J Clin Oncol 27: 3007-3013. (C) 2009 by American Society of Clinical Oncology
Keywords:	resection; therapy; induction chemotherapy; prognostic-factors; hemithoracic radiation; criteria
Journal Title:	Journal of Clinical Oncology
Volume:	27
Issue:	18
ISSN:	0732-183X
Publisher:	American Society of Clinical Oncology
Date Published:	2009-06-01
Start Page:	3007
End Page:	3013
Language:	English
ACCESSION:	ISI:000267133300021
DOI:	10.1200/jco.2008.20.3943
PROVIDER:	wos
PMCID:	PMC3646305
PUBMED:	19364962
Notes:	--- - Proceedings Paper - "Source: Wos"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/2212