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Does maintenance pemetrexed (Alimta) after first-line chemotherapy prolong progression-free survival?

Study notes

The short answer is: no.

Maintenance pemetrexed (Alimta) following standard treatment of pemetrexed (Alimta)/cisplatin does not prolong progression-free survival in patients with pleural mesothelioma. It is important to note that progression-free survival is not the same as overall survival. Progression-free survival is the time from starting therapy until the time of discovery that disease progressed. This study’s conclusions pertain to progression-free survival only.

The authors of this study include: Arkadiusz Z. Dudek, Xiaofei F. Wang, Lin Gu, Tom Stinchcombe, Robert Arthur Kratzke, Everett E. Vokes and Hedy L. Kindler.

“Patients who finish four to six cycles of initial therapy should, while enjoying a break from therapy, be monitored closely for disease progression, and at the time of disease progression seek participation in clinical trial, or be offered return to pemetrexed and platinum treatment,” said Dr. Arkadiusz Dudek.

This finding was presented last week at the American Society for Clinical Oncology’s annual conference in Chicago. These were results of a randomized Phase 2 trial in which patients, after standard initial four to six chemotherapy treatments, were assigned to either receive maintenance therapy or not. The difference in median progression-free survival between the observation arm and the treatment arm was less than 2 weeks (3.4 months PFS in patients receiving pemetrexed and 3 months in patients not receiving any therapy – the difference was not significant). 

However, the treatment was well tolerated reporting no grade 5 toxicities, and infrequent grade 4 toxicities. Also, the same study reported that although median overall survival for treatment arm was noted to be 16.3 months, as compared to 11.8 months for the observation arm, the survival curves in both groups were overlapping, proving that the difference was unlikely real.

Pemetrexed (Alimta) in combination with cisplatin is a chemotherapy treatment for mesothelioma approved by the FDA in 2004.

The Mesothelioma Applied Research Foundation is the only 501(c)(3) nonprofit organization working to eradicate mesothelioma and end this national tragedy. Its programs include the funding of promising and peer-reviewed research, education, support and advocacy. The organization strives to bring together thought-leaders in the field to identify the most direct path to a cure.

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