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A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II–III malignant pleural mesothelioma☆

A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy,... Objective: From therapeutic nihilism to extremely aggressive management, there is a wide range of possibilities in the treatment of malignant pleural mesothelioma (MPM). Unfortunately, there is little evidence as regards the best treatment to offer to the MPM patients. In 1999, we started a phase II study based on the multimodality treatment of stage II–III MPM, the results of which have been analysed and reported. Methods: From 1999 to 2004, 49 patients with IMIG stage II–III MPM underwent a multimodality treatment including: intrapleural pre-operative interleukin 2 (IL-2, 18 × 106 UI/day per 3 days), pleurectomy/decortication, intrapleural post-operative epidoxorubicin (25 mg/m2 per 3 days), IL-2 (18 × 106 UI/day per 3 days), adjuvant radiotherapy (30 Gy), systemic chemotherapy (cisplatin 80 mg/m2 day 1, gemcitabine 1250 mg/m2 day 1 and 8 up to 6 courses) and long-term sub-cutaneous IL-2 (3 × 106 UI/day 3 days per week). Results: There were 41 males and 8 females with a median age of 61 years (range 41–77). All the patients had a diagnosis of MPM by thoracoscopy before inclusion. We did not experience any post-operative mortality. The histology was: 39 epitheliomorf, 6 bifasic and 4 sarcomatous. According to the IMIG the post-operative staging was III in 40 cases and II in 9 cases. With a median follow-up of 59 months (range 14–81) 13 patients are still alive and the median actuarial survival is 26 months (31 and 21 months for stage II and III, respectively). Only the Performance Status at the diagnosis affected survival significantly. Conclusions: The multimodality treatment we adopted for stage II–III MPM was feasible, well tolerated by most of the patients and produced a favourable outcome. New targeted therapies are awaited for further improvements in the treatment of this disease. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II–III malignant pleural mesothelioma☆

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References (30)

Publisher
Oxford University Press
Copyright
© 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Subject
Original Articles
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1016/j.ejcts.2006.11.046
pmid
17188885
Publisher site
See Article on Publisher Site

Abstract

Objective: From therapeutic nihilism to extremely aggressive management, there is a wide range of possibilities in the treatment of malignant pleural mesothelioma (MPM). Unfortunately, there is little evidence as regards the best treatment to offer to the MPM patients. In 1999, we started a phase II study based on the multimodality treatment of stage II–III MPM, the results of which have been analysed and reported. Methods: From 1999 to 2004, 49 patients with IMIG stage II–III MPM underwent a multimodality treatment including: intrapleural pre-operative interleukin 2 (IL-2, 18 × 106 UI/day per 3 days), pleurectomy/decortication, intrapleural post-operative epidoxorubicin (25 mg/m2 per 3 days), IL-2 (18 × 106 UI/day per 3 days), adjuvant radiotherapy (30 Gy), systemic chemotherapy (cisplatin 80 mg/m2 day 1, gemcitabine 1250 mg/m2 day 1 and 8 up to 6 courses) and long-term sub-cutaneous IL-2 (3 × 106 UI/day 3 days per week). Results: There were 41 males and 8 females with a median age of 61 years (range 41–77). All the patients had a diagnosis of MPM by thoracoscopy before inclusion. We did not experience any post-operative mortality. The histology was: 39 epitheliomorf, 6 bifasic and 4 sarcomatous. According to the IMIG the post-operative staging was III in 40 cases and II in 9 cases. With a median follow-up of 59 months (range 14–81) 13 patients are still alive and the median actuarial survival is 26 months (31 and 21 months for stage II and III, respectively). Only the Performance Status at the diagnosis affected survival significantly. Conclusions: The multimodality treatment we adopted for stage II–III MPM was feasible, well tolerated by most of the patients and produced a favourable outcome. New targeted therapies are awaited for further improvements in the treatment of this disease.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Mar 1, 2007

Keywords: Keywords Mesothelioma Multimodality treatments Pleurectomy Chemotherapy Immunotherapy

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