Abstract
Mesothelioma is a malignancy of serosal membranes. Parietal pleura is the most common site, with peritoneum being the second most frequent location. Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. The prognosis is often very poor with median overall survival ranging from 6 to 18 months in patients who are not candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) due to non-resectable disease or comorbid conditions. For patients with resectable disease, CRS and HIPEC have become the standard of care. However, for patients with unresectable malignant mesothelioma there is unfortunately no effective systemic treatment beyond the first line. Based on the results of a recent phase II trial, lurbinectedin has clinical activity and acceptable toxicity in the second- and third-line treatment of malignant pleural mesothelioma. However, until present, no data have been available for patients with MPM and for patients who become refractory after multiple treatment lines. We report on two patients with metastatic MPM who achieved durable disease control of 10+ and 8 months with lurbinectedin in the fourth and fifth treatment line, respectively.
Highlights
Malignant mesothelioma arises from mesothelial cells of the pleural, peritoneal, or pericardial linings
Lurbinectedin is an analogue of trabectedin and a selective inhibitor of oncogenic transcription that binds preferentially to guanines located in the GC-rich regulatory areas of DNA gene promoters [8, 9]
The primary endpoint of progression-free survival (PFS) at 12 weeks was met by 52.4% of patients; median PFS and median overall survival were 4.1 months and 11.1 months, respectively
Summary
Malignant mesothelioma arises from mesothelial cells of the pleural, peritoneal, or pericardial linings. The patient’s tolerance to the treatment was very good with grade 1 asthenia, grade 1 diarrhea, and grade 1 abdominal pain that could be managed with standard supportive measures Restaging PET/CT examinations performed at 3, 6, and 9 months of treatment initiation showed an overall metabolic regression of the previously described pleural and peritoneal lesions (Figure 1C). The patient showed very good tolerance to the treatment with only grade 1 asthenia and grade 1 abdominal pain, which were manageable with standard measures. The patient is still alive with no substantial clinical deterioration
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