Annals of Oncology Advance Access originally published online on July 6, 2005
Annals of Oncology 2005 16(10):1711; doi:10.1093/annonc/mdi303
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© 2005 European Society for Medical Oncology
Letter to the Editor |
Cisplatin and gemcitabine in malignant mesothelioma
We read with interest Steele and Klabatsa's review of chemotherapy in malignant mesothelioma [1
]. Whilst we welcome the randomised evidence for a survival benefit from pemetrexed and cisplatin, we believe the activity of gemcitabine and cisplatin in this disease has been misrepresented. The authors correctly reported our single centre study of this combination, with a response rate of 48% (95% CI 26% to 69%) in 21 patients [2]. However, they have not reported that this study was followed with a multicentre phase II study of the same combination and schedule in 53 patients, giving a response rate of 33% (95% CI 20% to 46%) [3] and supporting the ability of this regimen to palliate some of the worst-rated symptoms of this disease [4]. These studies used a 28-day regimen with cisplatin 100 mg/m2 on day 1 and gemcitabine 1000 mg/m2 on days 1, 8 and 15. Trials showing lower response rates (16% and 26%) for this combination used 21-day schedules, with cisplatin doses of 75–80 mg/m2 [5, 6]. Furthermore, these trials used WHO response criteria in a disease in which bi-dimensional measurement of tumour response is probably inappropriate [7]. Unfortunately, whilst we would welcome a randomised comparison of cisplatin and pemetrexed versus cisplatin and gemcitabine in this disease, this is unlikely to occur as the same pharmaceutical company manufactures both pemetrexed and gemcitabine.
1 Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, 6009 Australia; 2 Department of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, 6009 Australia
* E-mail: anowak{at}cyllene.uwa.edu.au or Anna.Nowak{at}health.wa.gov.au
References
1. Steele JPC, Klabatsa A. Chemotherapy options and new advances in malignant pleural mesothelioma. Ann Oncol 2005; 16: 345–351.
2. Byrne MJ, Davidson JA, Musk AW et al. Cisplatin and gemcitabine treatment for malignant mesothelioma: A phase II study. J Clin Oncol 1999; 17: 25–30.
3. Nowak AK, Byrne MJ, Williamson R et al. A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma. Br J Cancer 2002; 87: 491–496.[CrossRef][Web of Science][Medline]
4. Nowak AK, Stockler MR, Byrne MJ. Assessing quality of life during chemotherapy for pleural mesothelioma: feasibility, validity, and results of using the European Organization for Research and Treatment of Cancer core quality of life questionnaire and lung cancer module. J Clin Oncol 2004; 22: 3172–3180.
5. Van Haarst JMW, Baas P, Manegold C et al. Multicentre phase II study of gemcitabine and cisplatin in malignant pleural mesothelioma. Br J Cancer 2002; 86: 342–345.[CrossRef][Web of Science][Medline]
6. Castagneto B, Zai S, Dongiovanni V et al. Cisplatin and gemcitabine in malignant pleural mesothelioma: A phase II study. Proc Am Soc Clin Oncol 2003; 22: 656 (Abstr 2637).
7. Byrne MJ, Nowak AK. Modified RECIST criteria for assessment of response in malignant pleural mesothelioma. Ann Oncol 2004; 15: 257–260.
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  B. Castagneto, M. Botta, E. Aitini, F. Spigno, D. Degiovanni, O. Alabiso, M. Serra, A. Muzio, R. Carbone, R. Buosi, et al. Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma (MPM) Ann. Onc., February 1, 2008; 19(2): 370 - 373. [Abstract] [Full Text] [PDF]
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