title: Pemetrexed as second-line treatment in malignant pleural mesothelioma after platinum-based first-line treatment.
abstract: BACKGROUND
  Pemetrexed is active as first-line treatment of malignant pleural mesothelioma. The objective was to evaluate its activity as second-line treatment.
  
  
  METHODS
  Patients had disease progression of malignant pleural mesothelioma after previous platinum-based regimens without pemetrexed. Treatment was pemetrexed alone or pemetrexed combined with carboplatin. Pemetrexed dosing was 500 mg/m and carboplatin was AUC (area under the curve) 5 once every 3 weeks.
  
  
  RESULTS
  Thirty-nine patients were included: 28 Danish patients received pemetrexed (three patients received pemetrexed as third-line treatment), whereas 11 Norwegian patients received pemetrexed plus carboplatin. Most patients were men (90%), had epithelial subtype (85%), and International Mesothelioma Interest Group stages III to IV (77%). Median age was 62 years (range, 30-77). The median number of treatment courses was six (range, 1-23). Common Toxicity Criteria grade 3 to 4 toxicity occurred only with respect to leukocytopenia (pemetrexed: 14% of patients; pemetrexed plus carboplatin: 9%) and thrombocytopenia (pemetrexed: 7%; pemetrexed plus carboplatin: 18%). One patient receiving pemetrexed died of sepsis. Partial response rates were 21% and 18%, the median time to progression was 21 weeks (range, 4-92) and 32 weeks (range, 4-128+), and the median survival was 42 weeks (range, 4-99) and 39 weeks (range, 10-128+) with pemetrexed and pemetrexed plus carboplatin, respectively.
  
  
  CONCLUSIONS
  Pemetrexed was generally well tolerated with noteworthy activity in malignant pleural mesothelioma after previous platinum-based treatment and may be considered for second-line treatment.
authors.affiliation: Department of Oncology, Finsen Centre/National University Hospital, Copenhagen, Denmark. jbsonk@rh.dk
authors.forename: Jens Benn
authors.initials: JB
authors.lastname: Sørensen
authors.forename: Stein
authors.initials: S
authors.lastname: Sundstrøm
authors.forename: Katharina
authors.initials: K
authors.lastname: Perell
authors.forename: Anne-Kathrine
authors.initials: AK
authors.lastname: Thielsen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005971:Glutamates / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy*; D008875:Middle Aged; D000068437:Pemetrexed; D017671:Platinum Compounds / Q000627:therapeutic use; D010997:Pleural Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D017671:Platinum Compounds; D000068437:Pemetrexed; D006147:Guanine; D016190:Carboplatin