Author of

• 15577

  +

  P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 15589

    +

    P3.08-012 - Renal Safety of Sustained Pemetrexed/Platinum Treatment for Advanced Malignant Mesothelioma (ID 1037)

    09:30 - 09:30  |  Author(s): M. Karthaus
    • Abstract

    Background:
    Advanded malignant peritoneal mesothelioma (AbM) is a rare and aggressive neoplasm. The natural course of the disease is different from pleural mesothelioma. The optimal ctx duration for AbM remains undetermined. Ctx of AbM is commonly reported case by case. Efficacy of Pemetrexed (Pem)+cisplatinum (DDP) ctx has been demonstrated previously. A major obstacle to sustained Pem/DDP for AbM is renal safety beside neurotoxicity. At present, there are sparse data regarding renal safety in AbM pts receiving sustained ctx >6 cycles of Pem+platinum.
    
    Methods:
    We evaluated long-term renal safety of Pem (500 mg/m[2])+DDP (75 mg/m[2]) in AbM prospectively. Ctx was given on d1 and repeated on d22 until disease progression or toxicity. Pts with impairment of renal function (Crea-Cl <60 ml/min) switched to carboplatin AUC5 (carbo). Pem ctx was stopped with a decline of Crea-Cl <45 ml/min. The trial was in accordance with the local ethics. Folic acid 400 μg po/d and vitamin B12 1000 μg i.m. qw 9 wks was administered to prevent severe AE. All pts received best supportive care with pre and post hydration as well as antiemetics including 5-HT3 antagonists and dexamethasone according to local standard of care. Study endpoints were long term renal safety in patients receiving sustained therapy of Pem + DDP followed by carbo and/or Pem-mono.
    
    Results:
    Between 2002 and 2014 staging revealed AbM in 19 pts. Initial ctx was Pem/DDP in 18 pts, except one who died prior to Tx. Ctx with Pem was given a mean of 12 cycles (range 1 to 37) with a mean of 259 d(range 21 to 1151). Mean dose of DDP was 678 mg(range 130 to 1335). Mean S-Crea(Crea-Cl) was 0,79 mg/dl(113 ml/min) prior and 0,95 mg/dl(97,4 ml/min) at the end of Pem/DDP. Pem/DDP was administered >6 cycles in 8 pts up to a max. of 10 cyles. DDP was stopped due to a decline in S-Crea in 6 out of 18 pts (33%). Renal tox was the reason for DDP cessation in all pts with >6 cycles, except 1. Five pts switched then to carbo due to renal tox with S-Crea(Crea-Cl) of 1,1 mg/dl(83 ml/min) prior and 1,2 mg/dl(79 ml/min) at the end of Pem/carbo. No renal toxicity was observed in those 4 pts with Pem-mono (max 10 cycles) subsequently after platinum ctx with S-Crea(Crea-Cl) prior 1,25 mg/dl(69 ml/min) and 1,14 mg/dl(72,5 ml/min) respectively.
    
    Conclusion:
    Sustained treatment for AbM is feasible but limited by renal tox of DDP, while subsequent Pem +/- carbo did not lead to additional deterioration of renal function, allowing sustained ctx for AbM.