Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo, Italy. giovanni
Lung Cancer. 2011 Apr;72(1):73-7. doi: 10.1016/j.lungcan.2010.12.004. Epub 2011 Jan 8.
The role of second-line therapy in patients with malignant pleural mesothelioma (MPM) progressing after first-line pemetrexed-based chemotherapy (PBC) is currently undefined. Recent case series have suggested a possible role of re-treatment with PBC. In this observational study, the activity and safety of this therapeutic option was assessed in a consecutive series of cases. Patients with complete response (CR), partial response (PR) or stable disease (SD) lasting for at least 3 months after first-line PBC were retreated with PBC, either as second-line (2L) or further-line (>2L) therapy. Descriptive analyses of progression-free survival (PFS), overall survival (OS), response rate and toxicity are reported. Between October 2004 and July 2009, 31 patients (21 males and 10 females) received re-treatment with PBC as 2L (18 patients) or beyond 2L therapy (13 patients). Median age was 65 years (range 37-81). Fifteen patients were re-treated with pemetrexed alone, and 16 with a pemetrexed/platinum combination. An objective response was achieved in 6 patients (one CR and 5 PRs), for a response rate of 19%. Nine patients (29%) had SD after treatment. Overall, the disease control rate (DCR) was 48%. Median PFS and overall survival (OS) after re-treatment with PBC were 3.8 months and 10.5 months, respectively. PFS and OS after re-treatment with PBC were correlated with PFS achieved after first-line PBC (FL-PFS). Patients with a FL-PFS >12 months had a median PFS after re-treatment of 5.5 months, while patients with a FL-PFS ≤12 months had a median PFS after re-treatment of 2.5 months; no patient in this group was progression-free at 1 year. Toxicity was mild, with grade 3 or 4 hematological toxicity occurring in 9.7% of patients. In conclusion, re-treatment with PBC should be considered as second-line therapy in MPM patients achieving a durable (>12 months) disease control with first-line PBC. Further prospective evaluation of this therapeutic option is warranted.
在一线培美曲塞为基础的化疗（PBC）治疗后进展的恶性胸膜间皮瘤（MPM）患者中，二线治疗的作用目前尚未确定。最近的病例系列研究表明，重新使用培美曲塞治疗可能具有一定作用。在这项观察性研究中，评估了连续病例中这种治疗选择的活性和安全性。在一线 PBC 后至少 3 个月完全缓解（CR）、部分缓解（PR）或稳定疾病（SD）的患者，接受培美曲塞再次治疗，作为二线（2L）或进一步线（>2L）治疗。报告了无进展生存期（PFS）、总生存期（OS）、反应率和毒性的描述性分析。在 2004 年 10 月至 2009 年 7 月期间，31 名患者（21 名男性和 10 名女性）接受了培美曲塞二线（18 名患者）或二线以上（13 名患者）治疗。中位年龄为 65 岁（范围 37-81）。15 名患者单独接受培美曲塞治疗，16 名患者接受培美曲塞/铂类联合治疗。6 名患者（1 例 CR 和 5 例 PR）达到客观缓解，缓解率为 19%。9 名患者（29%）治疗后出现 SD。总的来说，疾病控制率（DCR）为 48%。二线培美曲塞治疗后的中位 PFS 和 OS 分别为 3.8 个月和 10.5 个月。二线培美曲塞治疗后的 PFS 和 OS 与一线培美曲塞（FL-PFS）后的 PFS 相关。FL-PFS ＞12 个月的患者二线培美曲塞治疗后的中位 PFS 为 5.5 个月，而 FL-PFS ≤12 个月的患者二线培美曲塞治疗后的中位 PFS 为 2.5 个月；该组无患者在 1 年内无进展。毒性较轻，9.7%的患者发生 3 或 4 级血液学毒性。总之，对于一线培美曲塞治疗后获得持久（＞12 个月）疾病控制的 MPM 患者，应考虑培美曲塞作为二线治疗。需要进一步前瞻性评估这种治疗选择。
