New combo drug regimen shows promise

Saturday, April 22, 2006

An Italian study (Sequential chemotherapy with cisplatin/gemcitabine (CG) followed by mitoxantrone/methotrexate/mitomycin (MMM) in patients with malignant pleural mesothelioma) published in the May 2006 Journal Lung Cancer describes a study of a new 2 phase combination drug regimen that shows good disease control coupled with decrease in trouble breathing and pain, with mild toxicity in Meso patients with inoperable disease.

54 patients with unresectable malignant pleural mesothelioma received a total of 5 different drugs given in 2 phases. In the first phase of treatment the patients received Cisplatin (Platinol) and Gemcitabine (Gemzar) (CG regimen) for 4 cycles with 3 weeks between cycles. Cisplatin and Gemcitabine were taken on day 1 and Gemcitabine alone on day 8 for each cycle. Phase 2 involved three additional drugs mitoxantrone (Novantrone), methotrexate and mitomycin (Mutamycin) (MMM regimen). All drugs taken on day 1 and followed every 3 weeks for 4 cycles. Mitomycin is taken only on the 1st and 3rd cycle.

Results
Complete Response (tumor disappeared) - 3 cases (5.6%).
Partial Response (tumor shrank) - 13 (24%).
Stable Disease (no change in tumor) - 33 (61%)
Disease Progression- 5 (9.2%)

The 1 year survival rate was 63% and about half of the patients experienced improvement in their shortness of breath and pain.

The first phase involves two classic chemtherapy agents which inhibit cell division and cell growth. The second phase also inhibit cell growth, especially quickly dividing cells like tumor cells.

It remains to be seen the eventual value of this regimen. The standard of care has progressed in recent years and this chemotherapy regimen may take its place there. Further studies are warranted to confirm the findings.

The side effects were mostly blood disorders commonly associated with chemotherapy such as low platelet counts and low white cell count.