A PHASE-II TRIAL OF DOSE-ESCALATED DOXORUBICIN AND IFOSFAMIDE MESNA IN PATIENTS WITH MALIGNANT MESOTHELIOMA

Background: This study investigated the feasibility and efficacy of do xorubicin dose-escalated chemotherapy in combination with ifosfamide i n patients with malignant mesothelioma. Patients and methods: In this single institution phase II study, 24 chemotherapy-naive, eligible pat ients were entered. The chemotherapy regimen consisted of doxorubicin 75 mg/m2 in combination with ifosfamide 5 gr/m2 given as a continuous 24 hour infusion, every 21 days with either rhG-CSF (5 mug/kg) or rhGM -CSF (250 mug/m2) as haematopoietic support from d3 to d14. Cycles wer e repeated every 3 weeks. Results: We treated 24 patients, of whom 22 are evaluable for tumour response. One of the two inevaluable patients died from a cerebral haemorrhage during a period of grade III thrombo cytopenia after the second course. In 7 patients a partial response wa s observed, resulting in a response rate of 32% (95% confidence interv al 13%-51%). Median response duration was 6 months (range 1-13) and me dian survival was 7 months (range 1-18). Conclusions: The high-dose re gimen with growth factor support is feasible in this group of patients and leads to an interesting response rate. The limiting toxicity for further dose increments and more courses of treatment, was cumulative thrombocytopenia. There seems to be a subgroup of patients with malign ant mesothelioma which is less susceptible to develop thrombocytopenia . However, the overall toxicity and the poor response duration limit t he use of this schedule in the treatment of malignant mesothelioma.