Mesothelioma Progression and Evaluation
Mesothelioma Progression and Evaluation
Another interesting study is called, "Pemetrexed as Second-Line Treatment in Malignant Pleural Mesothelioma after Platinum-Based First-Line Treatment" by Srensen, Jens Benn MD, DMSc, MPA; Sundstrm, Stein MD, DMS; Perell, Katharina MD; Thielsen, Anne-Kathrine MD - Journal of Thoracic Oncology: February 2007 - Volume 2 - Issue 2 - pp 147-152. Here is an excerpt: "Abstract - Introduction: Pemetrexed is active as first-line treatment of malignant pleural mesothelioma. The objective was to evaluate its activity as second-line treatment. Methods: Patients had disease progression of malignant pleural mesothelioma after previous platinum-based regimens without pemetrexed. Treatment was pemetrexed alone or pemetrexed combined with carboplatin. Pemetrexed dosing was 500 mg/m2 and carboplatin was AUC (area under the curve) 5 once every 3 weeks.
Results: Thirty-nine patients were included: 28 Danish patients received pemetrexed (three patients received pemetrexed as third-line treatment), whereas 11 Norwegian patients received pemetrexed plus carboplatin. Most patients were men (90%), had epithelial subtype (85%), and International Mesothelioma Interest Group stages III to IV (77%). Median age was 62 years (range, 30-77). The median number of treatment courses was six (range, 1-23). Common Toxicity Criteria grade 3 to 4 toxicity occurred only with respect to leukocytopenia (pemetrexed: 14% of patients; pemetrexed plus carboplatin: 9%) and thrombocytopenia (pemetrexed: 7%; pemetrexed plus carboplatin: 18%). One patient receiving pemetrexed died of sepsis. Partial response rates were 21% and 18%, the median time to progression was 21 weeks (range, 4-92) and 32 weeks (range, 4-128+), and the median survival was 42 weeks (range, 4-99) and 39 weeks (range, 10-128+) with pemetrexed and pemetrexed plus carboplatin, respectively.
Conclusions: Pemetrexed was generally well tolerated with noteworthy activity in malignant pleural mesothelioma after previous platinum-based treatment and may be considered for second-line treatment.
Another interesting study is called, "The cytologic diagnosis of mesothelioma." By
Ehya H. - Semin Diagn Pathol. 1986 Aug;3(3):196-203. Here is an excerpt: "Abstract - The cytologic features of malignant mesothelioma cells in serous effusions are presented. Carcinomatous mesotheliomas are characterized by abundant neoplastic cells occurring singly and in clusters. The optically dense cytoplasm with lacy peripheral vacuoles, scalloped borders of cell clusters, intercellular spaces, "cell-in-cell" arrangement, and frequent multinucleation of cells are features of malignant mesothelioma, but none is pathognomonic of this tumor. A positive cytoplasmic staining of tumor cells with periodic acid-Schiff (PAS) after diastase digestion, and with mucicarmine stain after hyaluronidase treatment are against the diagnosis of mesothelioma, while positive staining with alcian blue, which becomes negative after the treatment with hyaluronidase is strongly suggestive of mesothelioma. The tumor cells react with antibodies to cytokeratin and vimentin, and do not react with carcinoembryonic antigen. Ultrastructurally, mesothelioma cells are characterized by long slender branching microvilli and numerous pinocytotic vesicles. They lack mucin vacuoles and intracellular lumens. An accurate diagnosis of mesothelioma depends on a full knowledge of the clinical history and radiologic findings, and proper application of histochemical, immunodiagnostic, and electron microscopic techniques."
Another interesting study is called, "Analysis of hyaluronic acid in the diagnosis of malignant Mesothelioma" by Brian Chiu MD, Andrew Churg MD, Anders Tengblad PHD, Richard Pearce PHD, W. T. E. McCaughey MD Cancer Volume 54, Issue 10, pages 21952199, 15 November 1984. Here is an excerpt: "Abstract - Using a modified papain digestion cetylpyridinium salt precipitation method, glycosaminoglycans were isolated from 21 mesotheliomas, 34 primary lung carcinomas, 12 carcinomas of other sites, and 7 soft tissue sarcomas. Qualitatively, hyaluronic acid (HA) was present in 20 of 21 mesotheliomas, about half of the primary lung adenocarcinomas, and all of the soft tissue sarcomas. On the average, HA constituted 45% of the total glycosaminoglycans in the mesotheliomas and 28% of the total in the lung cancers. Quantitatively, mesotheliomas contained statistically greater amounts (mean value, 0.74 mg/g) of HA than primary lung adenocarcinomas (mean value, 0.08 mg/g), but were not statistically different from soft tissue sarcomas (mean value, 2.01 mg/g) or primary ovarian serous neoplasms (mean value, 0.92 mg/g). The study concludes that, contrary to previous reports, HA is neither the sole nor the predominant glycosaminoglycan in most mesotheliomas, but, given the proper clinical and histologic setting, the finding of sufficiently high levels (greater than 0.4 mg/g dry tissue extract) supports the diagnosis of mesothelioma when the alternative diagnosis is primary adenocarcinoma of lung."
We all owe a debt of gratitude to these fine researchers. If you found any of these excerpts interesting, please read the studies in their entirety.
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