Docetaxel and irinotecan (CPT-11) in the treatment of malignant pleural mesothelioma - a feasibility study

We chose to treat malignant pleural mesothelioma with a combination of doce taxel and irinotecan (CPT-11), because there have been preliminary reports that CPT-11 is active against mesothelioma, and docetaxel and CPT-11 were t he most active agents in our in vitro experiments in human mesothelioma cel l lines. Fifteen previously untreated patients with pleural mesothelioma (I MIG Stage III-IV) were given docetaxel 60 mg/m(2) followed by CPT-11 190 mg /m(2) on day 1, repeated every 3 weeks. All the patients were evaluable for toxicity and 13 patients were evaluated for response. No objective respons es (complete or partial) were achieved, but there were two minor responses (overall response rate 15%) each of a duration of 4 months. Three patients had stable disease (23%); median time to progression was 7 months. Median s urvival in all the patients was 8.5 months from the first chemotherapy cycl e and 11 months from diagnosis. Toxicity was severe with seven of 15 patien ts suffering neutropenic fever and six of 15 patients grade 3-4 diarrhea. T he trial was discontinued because of toxicity and lack of activity. We do n ot recommend the combination of docetaxel and CPT-11 using the schedule pre sented here for further investigation in malignant mesothelioma. However, C PT-11 and docetaxel, individually, still warrant further study in this dise ase, especially in combination with cisplatin. [(C) 2000 Lippincott William s & Wilkins.].