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Lee, Ko, Seo, Lee, Choi, Lee, Kim, Lee, Yoo, and Lee: Dramatic Tumor Response to 2nd-line Pemetrexed/Cisplatin Combination Chemotherapy in Patient with Malignant Pleural Mesothelioma
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(5): 432-436.

Published online: 31 May 2007

DOI: https://doi.org/10.4046/trd.2007.62.5.432

Dramatic Tumor Response to 2nd-line Pemetrexed/Cisplatin Combination Chemotherapy in Patient with Malignant Pleural Mesothelioma

Seung Min Lee, M.D.1, Soon Young Ko, M.D.1, Tae Ho Seo, M.D.1, Jung Hyun Lee, M.D.1, Seung Oh Choi, M.D.1, Jeong Geun Lee, M.D.2, Wan Seop Kim, M.D.3, Tae Hoon Lee, M.D.1, Gwang Ha Yoo, M.D.1, Kye Young Lee, M.D.1

1Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea.

2Department of Radiology, College of Medicine, Konkuk University, Seoul, Korea.

3Department of Pathology, College of Medicine, Konkuk University, Seoul, Korea.

Address for correspondence: Kye Young Lee, M.D. Respiratory Center, Konkuk University Hospital, 4-12 Hwayang-dong, GwangJin-gu, Seoul, 143-729, Korea. Phone: 82-2-2030-7521, Fax: 82-2-2030-7748, kyleemd@kuh.ac.kr

Received 26 March 2007       Accepted 3 May 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumor that is difficult to clearly distinguish from an adenocarcinoma but usually has a poor prognosis. Numerous cytotoxic agents have been used in the primary treatment of MPM with limited success. A complete response is unusual and a partial response occurs in less than one-third of patients. Recently, a phase III trial showed that a combination of pemetrexed with cisplatin resulted in a significantly higher response rate and median survival time than with cisplatin alone.
We encountered a case of a dramatic tumor response to pemetrexed/cisplatin combination chemotherapy in patients with MPM, which was resistant to the 1st-line gemcitabine/cisplatin therapy. After six cycles of pemetrexed/cisplatin combination chemotherapy, the tumor volume had decreased dramatically with complete symptom relief. There was no chemotherapy-related toxicity or scheduled violation. The patient is under maintenance chemotherapy with the same regimen.

Keywords: Malignant pleural mesothelioma, Pemetrexed, Cisplatin

Figures and Tables

Figure 1
The initial chest PA shows right side massive pleural mass with effusion.
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Figure 2
A) The tumor shows epithelioid mesothelioma with tubulopapillary pattern. The cells lining the tubules and papillae are cuboidal and relatively bland (H&E, ×200). B) Mesothelioma showing strong nuclear and cytoplasmic positivity for calretinin (Calretinin stain, ×200).
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Figure 3
The following chest CT scan shows tumor progression after first line chemotherapy with gemcitabine/cisplatin. Large soft tissue mass of right pleura with multifocal loculated effusion compress lung parenchyma. No remarkable mediastinal lymph node enlargement is seen.
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Figure 4
The following chest CT scan shows that the pleural mass of rind with effusion was resolved dramatically after combination chemotherapy with pemetrexed/cisplatin.
trd-62-432-g004

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