An Australian experience of pemetrexed in malignant mesothelioma (MM)

Abstract

7285 Background: Pemetrexed and cisplatin have recently been shown to significantly improve survival compared to cisplatin alone. However there is only limited data available in a teaching hospital setting outside a clinical trial. Pemetrexed has only been available in Australia on a “special access scheme”(SAS) since 2002. We reviewed our experience of patients treated on the SAS at three major thoracic oncology units. Methods: Charts were reviewed for all patients enrolled on the scheme. Data was extracted on age, ECOG 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. All patients received vitamin B12 and folate supplementation. Doses were cisplatin 75 mg/m2 or carboplatin AUC=5 and pemetrexed 500mg/m2 every 21 days. Results: 52 patients (32 male and 20 female) were reviewed. Median age was 58 years. 88% were ECOG 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. 65% had minimal surgical intervention with video assisted thoracoscopy, pleurodesis and biopsy whilst 19% had received prior palliative radiation. 71% were chemotherapy naïve, the remaining 29% having received previous platinum and/or gemcitabine regimens. 23% had pemetrexed alone, 35% in combination with carboplatin and 42% with cisplatin. Median number of cycles was 4 (range 1–13). Response rate was 25%. No toxicity was observed in 20%, grade 3–4 toxicity in 10% (majority nausea/vomiting). Median progression free and overall survival times from starting pemetrexed were 184 days and 298 days respectively. Conclusions: Pemetrexed is safe and effective in a community setting in MM with results comparable to the recent phase III trial. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Eli Lilly Eli Lilly