Impressive remission in a patient with locally advanced malignant pleural mesothelioma treated with gemcitabine

The results of treatment of malignant pleural mesothelioma are quite unsati sfactory regardless of the substance or schedule employed. Although some ac tivity is proved for anthracyclines, platinum compounds and alyklating subs tances, no chemotherapeutic regimen has emerged as a standard of care. Resp onse rates documented in literature are between 10 and 20% for all these re gimens. We report about a patient with locally advanced, unresectable pleur al mesothelioma treated with the nucleoside analog gemcitabine (2,2-difluor odeoxycytidine). A 54-year-old male patient with unresectable pleural mesot helioma confirmed by thoracoscopic biopsy was treated with seven cycles of gemcitabine (1000 mg/m(2) on day 1, 8 and 15) over a period of 36 weeks. Re staging by thoracic computed tomography (CT) scan was performed after 8, 20 and 36 weeks. At week 36 after beginning of treatment, the CT scan exhibit ed a substantial partial remission with a reduction of tumor volume of over 50%. The adverse effects of the therapy were very moderate with a hematoto xicity not exceeding WHO grade I and a mild 'flu-like syndrome' during the first three cycles which responded quite well to steroids. The compliance o f the patient was excellent and his general condition improved significantl y under therapy. Gemictabine seems to be an active drug for the treatment o f pleural mesothelioma. Compared to other active regimens it is normally ve ry well tolerated by the patients. Because of these characteristics gemcita bine seems a suitable antineoplastic substance, especially in palliative se ttings. It would be worthwhile to test its activity in pleural mesothelioma s in controlled trials. [(C) 1999 Lippincott Williams 8 Wilkins.]