Retrospective review of pemetrexed with or without platinum in malignant mesothelioma: The Australian 'Special Access Scheme' experience

Background: Pemetrexed and cisplatin have recently been shown to significantly improve survival compared with cisplatin alone. However, there are only limited data reflecting teaching hospital experience outside a clinical trial. Pemetrexed has only been available in Australia on a restricted basis since 2002. We reviewed our experience of patients treated on the Australian ‘Special Access Scheme’ at three major thoracic oncology units. Methods: Charts were reviewed for all patients enrolled on the scheme. Data was extracted on age, World Health Organization (WHO) performance status, histology, prior therapy, time from diagnosis to starting pemetrexed, chemotherapy (pemetrexed alone or with a platinum), cycle number, response rate, actuarial progression‐free and overall survival. Doses were cisplatin 75 mg/m² or carboplatin AUC = 5 and pemetrexed 500 mg/m² every 21 days. Results: 52 patients (32 male and 20 female) were reviewed. Median age was 58 years and 88% were WHO 0–1. Histology included 54% epithelial, 17% biphasic (epithelial and sarcomatoid) and 21% undefined. The median time from diagnosis to administration of pemetrexed was 145 days. Sixty‐five percent had minimal surgical intervention with video assisted thoracoscopy, pleurodesis and biopsy, while 19% had received prior palliative radiation. Seventy‐one percent were chemotherapy naïve, the remaining 29% having received previous platinum and/or gemcitabine regimens. Twenty‐three percent had pemetrexed alone, 35% in combination with carboplatin and 42% with cisplatin. The median number of cycles was 4 (range 1–13). The response rate was 33%. No toxicity was observed in 20% grade 3–4 toxicity in 10% (majority nausea/vomiting). The median progression‐free and overall survival times from starting pemetrexed were 184 days and 298 days, respectively. Conclusions: Pemetrexed‐based regimens are safe and effective in a community setting in malignant mesothelioma.     

Characterization of spontaneous metastases from autochthonous 3-methylcholanthrene-induced tumors

In mice bearing autochthonous 3-methylcholanthrene-induced tumors metastasis was rare, with only 2 out of 47 (4%) animals showing lung secondaries and 1 showing kidney lesions. Surgical excision of autochthonous growing tumors brought only a slight increase in incidence of metastasis (5 out of 42 mice, 12%). Cell lines were established by in vivo and/or in vitro passage from two kidney metastasis found in the same host (0.13-K1 and 0.13-K3) and from a spontaneous lung metastasis found in 2 mice (mR80/43 and mR80/17) and compared to lines from the respective primary tumors (0.13; R80/17; R80/43). Cell lines from metastases and primary tumors were heterogeneous in tumorigenicity, growth rate, metastatic potential (spontaneous), and colonizing capacity (i.v. inoculation). In particular, the mR80-43 line was more metastatic to lungs upon intravenous injection than the parent R80-43 primary tumor. Similarly the 013-K1 line from a kidney secondary caused more lung nodules when inoculated intravenously than the parent 0.13 line, but this was not the case with the 013-K3 line derived from another kidney secondary in the same host. The R80-17 and mR80-17 lines had similar lung-colonizing capacity. Lung colonizing ability was not strictly correlated to the capacity to form spontaneous metastases. Changes in lung-colonizing capacity occurred in part of the lines (013, 013-K1, R80-17, mR80-17) upon in vitro or in vivo passage. These findings with lines from spontaneous metastases from three autochthonous sarcomas extend previous observations on the heterogenous behavior of transplanted metastatic neoplasms.