The Argument Against Chemotherapy as a Stand-Alone Treatment for Mesothelioma
In this article, Dr. Cameron expresses his opinion regarding the appropriate role of Alimta/cisplatin chemotherapy in the treatment of patients with malignant pleural mesothelioma.
In 2004, the FDA approved pemetrexed (Alimta®) in combination with cisplatin for the treatment of pleural mesothelioma. To this day, Alimta/cisplatin remains the only FDA approved chemotherapy drug combination for the treatment of mesothelioma.
The Resulting Hype
Following the FDA’s approval, the manufacturer conducted an aggressive marketing campaign of Alimta/cisplatin to general oncologists. This has resulted in the broad acceptance of this chemotherapeutic regimen as the de factostandard of care by general oncologists.
Physicians unfamiliar with mesothelioma who might have previously referred their patients to specialized mesothelioma treatment centers with experienced surgeons, medical and radiation oncologists, and pathologists and with advanced multimodality treatment protocols in place now often refer patients directly to community oncologists for treatment with Alimta/cisplatin alone.
The Limitations of Alimta/Cisplatin
Lost in the hype is the fact that the FDA’s approval is limited to use with patients who are not eligible for surgery(see the FDA approval letter, notice and package insert). Also the fact that, in its Phase III randomized trial, Alimta/cisplatin showed only a 41% partial response rate and an increased median survival rate of only 2.8 months compared to patients treated with cisplatin alone.
The Appropriate Role of Alimta/Cisplatin Chemotherapy
Published trial data show that the combination of surgery, radiation, and chemotherapy is almost always associated with the longest survival times for mesothelioma patients who are eligible for surgery. For this reason, many mesothelioma specialists believe that patients should consider surgery along with other therapies as part of a multimodality approach when the patient is a candidate for surgery.
Surgery can remove gross mesothelioma tumor in up to 85% of patients, equivalent to a complete pathological response, which compares to only a partial clinical response rate of 41% with Alimta/cisplatin alone. Following surgery, adjuvant therapies including chemotherapy and radiation may then be utilized to maintain a clinical remission. Furthermore, maintenance therapies such as immunotherapy, which are intended to continue to suppress microscopic disease and forestall the tumor’s recurrence, may provide even more long-term benefit.
Treating and managing mesothelioma as a chronic illness acknowledges the refractory nature of the disease to all therapies and focuses on coping rather than curing.
Chemotherapy is an important weapon in the treatment of malignant pleural mesothelioma. However, in patients who are otherwise eligible for surgery, it is probably best used in a well-planned multimodality therapy regimen.
The Importance of Obtaining a Surgical Consult Before Starting Alimta/Cisplatin Chemotherapy
Medical oncologists should counsel their mesothelioma patients to consult with a thoracic surgeon who has expertise in mesothelioma surgery, just as surgeons advise their patients to consult with a qualified medical oncologist about the potential benefits of adjuvant chemotherapy and radiation.
Patients who are evaluated and treated in a defined multimodality therapy regimen by a multidisciplinary team of physicians, including surgeons, medical oncologists, and radiation oncologists generally will be the most optimally managed and best served by their physicians.
Interested in Learning More?
If you have been diagnosed with malignant pleural mesothelioma and would like to learn more about Dr. Cameron’s approach to treating the disease, you may contact his office at (310) 470-8980.
Dr. Cameron sees patients in consultation at his Los Angeles, California clinic located at:
10780 Santa Monica Boulevard Suite 100 Los Angeles, California 90025-7613
If you are traveling from out of town and would like assistance with travel arrangements, contact the Pacific Meso Center at (310) 478-4678 or firstname.lastname@example.org.