title: A phase II trial investigating primary immunochemotherapy for malignant pleural mesothelioma and the feasibility of adjuvant immunochemotherapy after maximal cytoreduction.
abstract: BACKGROUND
  The treatment of malignant pleural mesothelioma (MPM) continues to be inadequate with the use of standard techniques, including surgery, radiotherapy and chemotherapy. We initiated a phase II trial of immunochemotherapy with cisplatinum (25 mg/m2 four times weekly), interferon-alpha (5 mU/m2 s.c. three times weekly, and tamoxifen (20 mg orally twice a day for 35 days) (CIT) based on in vitro and in vivo data suggesting interrelating efficacy of this combination.
  
  
  METHODS
  Since July 1991, 36 patients have been evaluable for response after receiving one to five cycles of CIT. Ten additional patients had debulking surgery followed by two cycles of postoperative adjuvant CIT commencing a mean of 6 weeks after surgery.
  
  
  RESULTS
  Toxicity was acceptable (4% grade III/IV). One treatment-related death (2%) occurred, from myocardial infarction. A 19% partial response rate, objectively quantified using three-dimensional computerized tomographic (CT) measurement of solid disease volume, was recorded. The median survival for the seven responders was 14.7 months, whereas that of the nonresponders was 8 months (p2 = 0.2). Median survival for the entire group was 8.7 months. Preoperative size, platelet count > 360,000/ml, and nonepithelial histology were associated with shortened survival.
  
  
  CONCLUSIONS
  The CIT regimen has some activity in MPM and can be delivered after debulking resection. In good-risk patients, as defined by favorable prognostic factors, a randomized trial using this combination may be warranted.
authors.affiliation: Thoracic Oncology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Pass
authors.forename: B K
authors.initials: BK
authors.lastname: Temeck
authors.forename: K
authors.initials: K
authors.lastname: Kranda
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: H I
authors.initials: HI
authors.lastname: Pass
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000494:pharmacology / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007167:Immunotherapy; D016898:Interferon-alpha / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013629:Tamoxifen / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D016898:Interferon-alpha; D013629:Tamoxifen; D002945:Cisplatin