Lee Christopher W, Murray Nevin, Anderson Helen, Rao Sanjay C, Bishop Winston
BC Cancer Agency - Fraser Valley Centre, 13750 96th Avenue, Surrey, British Columbia, Canada V3V 1Z2.
Lung Cancer. 2009 Jun;64(3):308-13. doi: 10.1016/j.lungcan.2008.09.008. Epub 2008 Nov 11.
Cisplatin plus pemetrexed has been standard systemic therapy for malignant pleural mesothelioma (MPM) since the landmark randomized trial reported in 2003. However, the combination of cisplatin and gemcitabine was incorporated into clinical practice following publication of promising phase II trial results in 1999. The impact of these platinum-based regimens is assessed in this review of practice in the province of British Columbia. All cases of MPM diagnosed from 1999 to 2005 were identified in a provincial registry using ICD-O codes. The clinical records of individuals referred to the BC Cancer Agency were reviewed, and those treated with a platinum analog plus gemcitabine or pemetrexed as first-line therapy were included in survival analyses. During the selected period, 81 patients were treated first-line with a platinum analog plus gemcitabine (n=40) or pemetrexed (n=41). Characteristics of the entire cohort include: age at diagnosis, mean 65 years (median 66, range 43-84); gender, male 70 (86%); laterality of disease, right-sided 51 (63%); histology, epithelioid or not otherwise specified 69 (85%). Median survival was 10 months (95% confidence interval, 7.7-12.3), with 1- and 2-year survival rates 0.42 and 0.21, respectively. Survival did not appear to be influenced by the chemotherapy agent used. Survival outcomes with chemotherapy for MPM in the province are comparable to what is reported in the literature. No difference is seen combining platinum analogs with gemcitabine or pemetrexed. Platinum-based doublets might represent a therapeutic ceiling for cytotoxic chemotherapy in MPM.
自2003年一项具有里程碑意义的随机试验报告以来，顺铂加培美曲塞一直是恶性胸膜间皮瘤（MPM）的标准全身治疗方案。然而，1999年发表了有前景的II期试验结果后，顺铂与吉西他滨的联合用药被纳入临床实践。在对不列颠哥伦比亚省的实践进行的本次综述中，评估了这些铂类方案的影响。使用ICD - O编码在省级登记处识别出1999年至2005年诊断的所有MPM病例。对转诊至BC癌症机构的患者的临床记录进行了审查，那些接受铂类类似物加吉西他滨或培美曲塞作为一线治疗的患者被纳入生存分析。在选定期间，81例患者接受了铂类类似物加吉西他滨（n = 40）或培美曲塞（n = 41）的一线治疗。整个队列的特征包括：诊断时年龄，平均65岁（中位数66岁，范围43 - 84岁）；性别，男性70例（86%）；疾病侧别，右侧51例（63%）；组织学类型，上皮样或未另行指定69例（85%）。中位生存期为10个月（95%置信区间，7.7 - 12.3），1年和2年生存率分别为0.42和0.21。生存似乎不受所用化疗药物的影响。该省MPM化疗的生存结果与文献报道相当。铂类类似物与吉西他滨或培美曲塞联合使用未见差异。铂类双联疗法可能代表了MPM细胞毒性化疗的治疗上限。
