The efficacy of pemetrexed and bevacizumab intrapleural injection for malignant pleural mesothelioma-mediated malignant pleural effusion.

OBJECTIVE: The aim of the present study was to evaluate the efficacy and safety of pemetrexed chemotherapy combined with intrapleural injection of pemetrexed and bevacizumab in the treatment of malignant pleural mesothelioma (MPM)‑mediated malignant pleural effusion, and analyze the objective response rate (ORR), the median progression‑free survival (PFS) and the median overall survival (OS). METHODS: We analyzed the clinical data of 23 MPM patients with pleural effusion who were treated with a combination chemotherapy of pemetrexed at 500 mg/m2, on day 1 plus cisplatin (DDP) at 20 mg/m2 on day 1–5 of each 21 days cycle, and concurrently, intrapleural injection of pemetrexed 0.5 g and bevacizumab 300 mg was administered on day 3 or day 4 after complete effusion drainage. ELISA test was applied to detect the vascular endothelial growth factor (VEGF) level in the pleural effusion and serum, and assess the ORR and survival. RESULTS: In the 23 evaluable patients, the VEGF level in the pleural effusion and serum was significantly decreased, P < 0.01, pleural effusion of 20 patients (86.96%) was controlled effectively. There were 8 complete responses, 7 partial responses, 5 stable disease and 3 progressive disease, the ORR was 65.21%, the disease control rate was 86.96%, the median PFS was 6 months, the median OS was 14.5 months, and the 1‑year survival rate was 41.22%. Toxicities were generally mild and manageable; the major toxicities included myelosuppression, fatigue, and anemia, mainly were grade 1–2 which could be managed by symptomatic treatments. CONCLUSION: The combination of pemetrexed chemotherapy with intrapleural injection of pemetrexed and bevacizumab is efficacious and safe for MPM pleural effusion, and results of the present study demonstrate some improvement in the PFS and OS. The expression of VEGF in the pleural effusion and serum plays a guiding role in monitoring the efficacy of bevacizumab in the treatment of malignant pleural effusion.

A Case of Successful Intrapleural Chemotherapy with Cisplatin Plus Cytarabine for Intractable Malignant Pleural Effusion

When conventional treatments of malignant pleural effusion, such as repeated thoracentesis, closed thoracotomy and pleurodesis by instilled sclerosing agents, are ineffective, there are few alternative therapies available. Our case involves a 47-year-old woman with uterine cervical carcinoma suffering from malignant pleural effusion. She presented with a chief complaint of severe dyspnea, and was classified as an Eastern Cooperative Oncology Group (ECOG) performance status of 4. Her underlying cervical carcinoma progressed despite various systemic chemotherapy regimens. In addition, pleural effusion persisted in spite of 4 weeks of drainage through the thoracotomy tube and talc pleurodesis. Under such circumstances, we attempted intrapleural chemotherapy with cisplatin plus cytarabine, which resulted in significant decrease of the pleural effusion. No serious systemic toxicities, including myelosuppression, were observed. As a result, the patient's dyspnea was relieved, and her ECOG performance status improved from 4 to 2. However, the thoracotomy tube was not removed due to subsequent iatrogenic pneumothorax. Pleural effusion did not recur for the 4 weeks leading up to her death.

Intrapleural Chemotherapy with Cisplatin and Cytarabine in the Management of Malignant Pleural Effusion / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate the efficacy of intrapleural chemotherapy (IPC) with cisplatin and cytarabine in the management of malignant pleural effusion (MPE) from non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: A prospective analysis was carried out on 40 patients with pathologically proven MPE from NSCLC who had received IPC. A single dose of cisplatin 100 mg/m2 plus cytarabine 1200 mg/m2 in 250 ml normal saline was instilled into the pleural space via a chest tube and drained 4 hours later. Patients were evaluated for toxicities and responses at 1, 2, & 3 weeks and then at monthly intervals if possible. Systemic chemotherapy was administered, if the patient agreed to receive it, after achieving complete control (CC) of MPE. RESULTS: The median duration of chest tube insertion for drainage was 7 (3~32) days. Among the assessable 37 patients, CC and partial control (PC) were 32 (86.5%) and 4 (10.8%) patients, respectively (overall response rate 97.3%). The median duration of response was 12 months (2~23) and there were only two relapses of IPC after achieving CC. Among the 35 patients who were assessable until they died, 28 patients (80.0%) maintained CC until the last follow-up. There was only one toxic death and the toxicities of IPC, versus the results obtained, were deemed acceptable. CONCLUSION: The procedures were tolerable to the patients and chemotherapy-induced complications were at an acceptable level. The outcome of this trial indicates that IPC has a superior and long lasting treatment response in the management of patients with MPE from NSCLC.

Intrapleural chemotherapy with cisplatin and cytarabine in the management of malignant pleural effusion / 대한내과학회지

BACKGROUND: Maligant pleural effusions are common and significant problems in patient with advanced malignancies. In comparison with traditional sclerosing agent, intrapleural chemotherapy has a potential advantage of treating the underlying malignancy in addition to providing local control of th effusion. This study evaluated efficacy of intrapleural chemotherapy with cisplatin and cytarabine in the management of malignant pleural effusion from lung cancer and others. METHODS: 29 patients with pathology-proven malignant pleural effusion were prospectively analyzed to estimate the effect of intrapleural chemotherapy. A single dose of cisplatin 100mg/m plus cytarabine 1200mg/m in the 250ml normal saline were instilled into the pleural space via a chest tube and drained 4 hours later. Patients were evaluated for toxicity and response at 24hours, 1st, 2nd, 3rd week, and monthly interval. No recurrence of the effusion was considered a complete response(CR). Partial responses (PR) was defined as a 75% or greater decrease in the amount of effusion on serial chest radiographs. RESULTS: The overall response rate(CR plus PR) was 93.1% (27 of 29 patients). The median length of response was 7.5 months. Among 17 patients who were assessable until they died, 14 patients(82%) maintained complete response at the last follow-up. One patient experienced reversible grade 4 myelosuppression, 3 patients had grade 3 nausea & vomiting. 2 patients had empyema, and 2 patients had wound infection. CONCLUSIONS: The outcome of this trial indicated that the intrapleural chemotherapy with cisplatin and cytarabine with little treatment related mortality and morbidity.