Pemetrexed (A)/platinum for patients with advanced malignant peritoneal mesothelioma (AbM)—The Bielefeld experience

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Background: AbM is a very rare and aggressive neoplasm of the peritoneum. Treatment data of AbM are commonly case reports. A is approved for pleural mesothelioma (MPM) with rare data however regarding AbM. Methods: We evaluated efficacy and safety data of A (500 mg/m2) +DDP (75 mg/m2) or carboplatin (AUC 5) in AbM prospectively. Ctx was given d1 and repeated on d22 for 6 cycles or disease progression. Folic acid 400 μg po/d and vitamin B12 1000 μg i.m. qw 9 wks was administered to prevent AE . Study endpoints were best response (CR/PR), time to progression (TTP), survival and safety. Results: 89 consecutive mesothelioma pts were observed from 12/2002 until 12/2005 in a German single center institution. Four pts (1 AbM, 1 MPM, 2 MPM+AbM) were excluded due to renal impairment (n = 1) or death prior to Ctx (n = 3). AbM was diagnosed in 22 pts (16 epitholoid, 1 sarcomatoid, 5 other), while 5 additional pts had mesothelioma on both sites of the diaphragma. Efficacy data are available in 19 pts with AbM and 5 pts with AbM + MPM. Initial combination was with DDP in 21 pts treated with AbM. DDP was given in 3 and carboplatin combination in 2 pts with MPM + AbM. A was administered a median of 6 cycles in AbM (range 1–33). Toxicity (WHO > III/IV) was nausea (n = 4) and neutropenia (n = 4). Up to 12/05 death has been reported in 8 out of 22 pts with AbM, and in 3 of 5 pts with AbM + MPM. Mean survival was 13,65 months (range 1 to 35+ months) in AbM. Benefit for AbM was 77% with objective RR in 36%. Mean TTP was 11,54 months (range 0 to 35+) in AbM vs 15,4 months with MPM + AbM with a mean survival of 13,65 months (range 0 to 35+) and 22,3 months (range 0 to 35+) in the latter group. Conclusions: Pemetrexed with platinum is well tolerated and has substantial activity for malignant peritoneal mesothelioma. Further trials are warranted to prove this hopeful concept of pemetrexed based therapy for advanced AbM.

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No significant financial relationships to disclose.

The corpus callosum in communicating and noncommunicating hydrocephalus

To investigate morphological changes in the corpus callosum in hydrocephalus and to correlate them with clinical findings we studied sagittal T2*-weighted cine MR images of 163 patients with hydrocephalus. The height, length and cross-sectional area of the corpus callosum were measured and related to the type of cerebrospinal fluid flow anomaly and to clinical features, especially dementia. With expansion of the lateral ventricles the corpus callosum showed mainly elevation of its body and, to a lesser degree, increase in length. Upward bowing was more pronounced in noncommunicating than in communicating hydrocephalus. Dorsal impingement on the corpus callosum by the free edge of the falx correlated with the height of the corpus callosum. Cross-sectional area did not correlate with either height, length or impingement; it was, however, the strongest anatomical discriminator between demented and nondemented patients. The area of the corpus callosum was significantly smaller in patients with white matter disease. Our findings suggest that, due to its plasticity, the corpus callosum can to some degree resist distortion in hydrocephalus. Dementia, although statistically related to atrophy of the corpus callosum, is possibly more directly related to white matter disease.

Polymorphism of human orosomucoid in populations of western Germany and Switzerland

The orosomucoid 1 (alpha-1-acid glycoprotein locus 1) gene frequencies have been studied in 670 individuals from Western Germany (Düsseldorf region) and in 220 individuals from Switzerland (Zürich region). The frequencies are ORM1*1 0.6269 and ORM1*2 0.3731 for Western Germany and ORM1*1 0.6068 and ORM1*2 0.3932 for Switzerland.

Effect of timolol on optic nerve head autoregulation

Healthy subjects show, in a special pressure compliance test of the optic nerve head, signs of autoregulation of optic nerve head circulation. In this test visual evoked response (VER) amplitudes were recorded during stepwise increased intraocular pressures. In the resulting VER amplitude/pressure curves glaucoma patients did not show the sign of autoregulation of optic nerve head circulation which is seen in healthy subjects. It is known that topically applied timolol maleate may affect optic nerve head circulation. Therefore the pressure compliance test was performed in 20 healthy eyes before and after 3 days of topically applied timolol maleate 0.5%. The aim of the study was to test the effect of topically applied timolol on optic nerve head autoregulation. In addition we determined the ocular perfusion pressures, heart rate and mean arterial blood pressure. While the ocular perfusion pressures show a slight, but statistically not significant, decrease under timolol, the systemic parameters and the autoregulation behavior did not change.