title: Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy.
abstract: BACKGROUND
  Malignant pleural mesothelioma (MPM) is an aggressive neoplasm that responds poorly to chemotherapy. Although treatment with pemetrexed in combination with cisplatin serves as first-line chemotherapy for MPM, the optimal second-line and beyond therapy has not yet been fully examined.
  
  
  METHODS
  Between March 2008 and October 2011, 17 consecutive Japanese patients pretreated with at least one regimen of platinum plus pemetrexed chemotherapy received gemcitabine and vinorelbine. Responses, survival time, and toxicity were retrospectively evaluated.
  
  
  RESULTS
  Response [partial response (PR) + complete response (CR)] and disease control [stable disease (SD) + PR + CR] rates were 18 and 82 %, respectively. The median progression-free survival (PFS) after combination chemotherapy was 6.0 months, whereas the median overall survival (OS) was 11.2 months. Grade 3 or 4 neutropenia and anemia were observed in 41 and 29 % of patients, respectively, and one patient experienced febrile neutropenia. Grade 3 or 4 nonhematologic toxicities included constipation (6 %) and phlebitis (6 %).
  
  
  CONCLUSIONS
  Combination chemotherapy using gemcitabine with vinorelbine was shown to have moderate activity in Japanese MPM patients pretreated with platinum plus pemetrexed chemotherapy. A further multicenter phase II trial is warranted to confirm the efficacy and safety of this combination treatment.
authors.affiliation: Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
authors.forename: Gouji
authors.initials: G
authors.lastname: Toyokawa
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takenoyama
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Hirai
authors.forename: Ryo
authors.initials: R
authors.lastname: Toyozawa
authors.forename: Eiko
authors.initials: E
authors.lastname: Inamasu
authors.forename: Miyako
authors.initials: M
authors.lastname: Kojo
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Morodomi
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Shiraishi
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Takenaka
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Shimokawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Seto
authors.forename: Yukito
authors.initials: Y
authors.lastname: Ichinose
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001194:Asbestos / Q000633:toxicity; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000473:pathology; D005260:Female; D005971:Glutamates / Q000008:administration & dosage*; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D010997:Pleural Neoplasms / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077235:Vinorelbine; D000093542:Gemcitabine
chemical_list: D005971:Glutamates; D000068437:Pemetrexed; D003841:Deoxycytidine; D001194:Asbestos; D014747:Vinblastine; D006147:Guanine; D002945:Cisplatin; D000077235:Vinorelbine; D000093542:Gemcitabine