First-line chemotherapy with liposomal doxorubicin plus cisplatin for patients with advanced malignant pleural mesothelioma: phase II trial

Background:

Chemotherapy based on platinum is the standard treatment for unresectable malignant pleural mesothelioma (MPM). Liposomal doxorubicin (LD) consists of pegylated phospholipid vesicles that encapsulate doxorubicin-enhancing liposome deposition in the tumour. We evaluated the toxicity profile and anti-tumour activity of cisplatin plus LD in untreated patients with MPM, as well as ^99mTc-LD distribution in MPM lesions after chemotherapy administration.

Methods:

A total of 38 patients with non-resectable MPM received LD 40 mg m⁻² and cisplatin 60 mg m⁻² every 21 days. Gamma camera images of ^99mTc-LD were acquired to evaluate LD accumulation in measurable tumour tissue. The study was registered in Clinical Trials (NCT00886028).

Results:

In all, 72% of patients were stage III and 28% were stage IV. Eighty four percent and 16% have high and low risk acording EORTC respectively. The median time to progression was 4.6 months (95% confidence interval (95% CI: 3.4–5.9 months), and median overall survival (OS) was 19.6 months (15.2–37.2 months). Patients that responded to chemotherapy treatment had better survival than patients who did not. Functional physical scales, dysnea, cough, and chest/arm pain demonstrated improvement. The accumulation ratio of LD in tumour and soft tissues vs liver was 0.78±0.16 and 0.29±0.09, respectively. After 1 h of administration, LD uptake in tumour tissue was higher than in soft tissue (P< 0.001).

Conclusion:

The combination of LD and cisplatin results in an active therapeutic regimen for unresectable MPM, with an acceptable toxicity profile and improvement in quality of life. ^99mTc-LD showed higher levels of tumour uptake as compared with surrounding tissues.

Vandetanib plus pemetrexed versus pemetrexed as second-line therapy in patients with advanced non-small cell lung cancer (NSCLC): A randomized, double-blind phase III trial (ZEAL)

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Background: Vandetanib is a once-daily oral inhibitor of VEGFR, EGFR and RET signaling. A phase I trial of vandetanib + pemetrexed (pem) supported further investigation of this combination (de Boer et al, Ann Oncol 2008). Methods: The primary objective was to determine whether vandetanib 100 mg/day + pem 500 mg/m2 every 21 days (max 6 cycles) prolonged progression-free survival (PFS) vs placebo + pem. Overall survival (OS), objective response rate (ORR), time to deterioration of symptoms (TDS, by Lung Cancer Symptom Scale) and safety were secondary endpoints. Efficacy and safety were assessed in females as a co-primary analysis population. Eligibility criteria included stage IIIB/IV NSCLC, PS 0–2, and previous 1st-line therapy. Results: Between Jan 07-Mar 08, 534 patients (mean age 59 yrs; 38% female; 21% squamous histology; 8% brain metastases; stage IV 84%; PS 0/1/2: 41%/53%/6%) were randomized 1:1 to receive vandetanib + pem (n=256) or placebo + pem (n=278). Baseline characteristics were similar in both arms. Median duration of follow-up was 9.0 months, with 83% patients progressed and 50% deceased. There were positive trends seen for vandetanib + pem for both PFS (hazard ratio [HR] 0.86, 97.58% CI 0.69–1.06; P=0.108) and OS (HR 0.86, 97.54% CI 0.65–1.13; P=0.219); similar advantages were observed for females. There were statistically significant advantages for ORR (19.1% vs 7.9%, P<0.001) and TDS (HR 0.61, P=0.004). The adverse event profile was consistent with previous studies of vandetanib: rash (38% vs 26%), diarrhea (26% vs 18%) and hypertension (12% vs 3%) being more frequent in the vandetanib arm. There was evidence of reduced pem toxicity with the addition of vandetanib: anemia 8% vs 22%, nausea 29% vs 37%, vomiting 15% vs 22%, fatigue 37% vs 45%, and asthenia 11% vs 17%. The incidence of protocol-defined QTc prolongation was <1%. There was no increase in bleeding or thrombotic events in the vandetanib arm. Conclusions: The combination of vandetanib + pem demonstrated evidence of clinical benefit in patients with pretreated advanced NSCLC, although the study did not meet the primary endpoint of statistically significant PFS prolongation vs pem alone. Vandetanib + pem was generally well tolerated.

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