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Tomudex® Plus Platinol® and Platinol Alone Reduce Dyspnea in Patients with Mesothelioma
Researchers affiliated with the European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Group and the National Cancer Institute of Canada have reported that the combination of Tomudex (raltitrexed) and Platinol® (cisplatin) or Platinol alone decrease dyspnea in patients with malignant pleural mesothelioma (MPM). The details of this randomized phase III trial evaluating quality of life parameters were reported in the March 20, 2006, issue of the Journal of Clinical Oncology.[1]
Malignant pleural mesothelioma is a rare cancer caused by chronic exposure to asbestos. Patients with this disease often have a decreased quality of life from symptoms caused by the cancer, such as shortness of breath, cough, pain, fatigue, and the inability to eat. This type of cancer is resistant to most therapies, which consist of surgery, chemotherapy, and/or radiation therapy. Furthermore, most people do not learn they have malignant pleural mesothelioma until the disease has progressed to an advanced stage when treatment with surgery or radiation is not an option. Therefore, identification of a chemotherapy regimen that can improve quality of life or survival is essential for improving care in this population.
Mesothelioma is regarded as relatively chemo-resistant, but recent studies have shown that significant palliation is possible with newer chemotherapy approaches. Platinol alone has been the standard by which other regimens are judged. However, there is emerging evidence that combining an anti-metabolite with a platinum compound may now be the current best approach to treating patients with MPM.
The anti-metabolite that has been studied the most is Alimta® (pemetrexed) which has been combined with Platinol producing results superior to Platinol alone. Tomudex is another anti-metabolite that is approved in Europe and Canada for use in the treatment of colon cancer. Tomudex is a prodrug that is converted to polyglutamates, which inhibit thymidylate synthase. Single agent Tomudex has demonstrated activity in the treatment of MPM.[2]
In the current trial, 25 patients with untreated MPM were randomly allocated to receive treatment with Platinol alone or Platinol plus Tomudex. The details of response and survival were reported last year in the Journal of Clinical Oncology and summarized below in Related News.[3] Essentially this study showed that the addition of Tomudex improved the response from 13% to 23.6% and prolonged median survival from 8.8 months to 11.4 months.
The current analyses report short term treatment-related complications and quality of life results. Assessments were made at baseline, after each treatment cycle, at the end of treatment and every 6 weeks for 6 months. This analysis confirmed the survival benefit of combination therapy reported in the original trial. This study did not find major differences in quality of life parameters between patients receiving Platinol alone or Platinol plus Tomudex. However, they did report that patients receiving either therapy had improvement in dyspnea after cycle 2 of therapy.
Comments: This study suggests that both therapies improve quality of life to the same degree. However, combination chemotherapy would be preferable since survival is improved.
Related News:
The Combination Oxaliplatin and Raltitrexed is Effective For Treatment of Inoperable Malignant Pleural Mesothelioma: Results of a Pilot Study(5/14/2002)
Alimta® Approved for Mesothelioma(2/5/2004)
Pemexetred (Altima®) plus Platinol® Extends Survival in Mesothelioma: First Therapy to Make a Difference (7/14/2003)
References
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[1] Bottomley A, Gasfa R, Manegold C, et al. Short-term treatment-related symptoms and quality of life: Results from an International Randomized Phase III Study of cisplatin with or without raltitrexed in patients with malignant pleural mesotheliama: An EORTC Lung Cancer Group and National Cancer Institute, Canada, Intergroup Study. Journal of Clinical Oncology. 2006;24:1435-1442.
[2] Baas P, ardizzoni A, Grossi F, et al. EORTC Lung Cancer Group: The activity of raltitrexed (Tomudex) in malignant pleural mesothelioma: An EORTC phase II study (08992). European Journal of Cancer. 2003;39:353-357.
[3] Van Meerbeeck JP, Gaafar R, Manegold C, et al. Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Reserch and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. Journal of Clinical Oncology. 2005;23:6881-6889.
Asbestos find suspends search
By AP
NEW YORK -- Officials suspended the search for human remains on the roof of an empty building near the World Trade Center site after asbestos was discovered there.
Nearly 600 bone fragments and other human remains have been found on the former Deutsche Bank building in recent months as workers clean it in preparation for tearing the building down later this year.
Environmental Protection Agency spokesman Mary Mears said yesterday that the search for more remains was suspended after an EPA and department of labour inspection found the roof area was "not properly cleaned."
Follow-up testing by the Lower Manhattan Development Corp., which owns the building, determined some dust particles contained asbestos.
The 41-storey building was severely damaged during the Sept. 11, 2001, attack, when the trade centre's south tower partially collapsed on it.
“I Won’t Give Up” – One Lung Cancer Patient’s Story
Sing Tao Daily, News Feature, Shirley Chou, Translated by Eugenia Chien
Aug 06, 2006 - SACRAMENTO – With a sunny personality and youthful voice, Angie Lee-Ow is a 55-year-old pharmacist who rarely got sick. In May, 2005, Lee-Ow had taken a few days to clean her house in preparation for a friend who was visiting her from Germany. A few days later, she could hardly make her way up the stairs in her house because of exhaustion and shoulder pain.
Upon her friends’ urging, Lee-Ow saw a doctor the next day. X-rays showed ominous shadows in her lungs, where water had accumulated. A few days later, after more testing, doctors found that she had Non-Small Cell Stage lung cancer – the last stage of lung cancer. The cancer had spread to her bones, which explained why her shoulders were in pain.
Lung cancer is the number one killer of Asian Pacific Americans, men or women. Lee-Ow is among the 25,000 new lung cancer patients who are non-smokers. The majority of these non-smokers are women.
Lee-Ow is a Chinese American who grew up in the Bay area and eventually settled in Sacramento in the 1970s with her husband and their two daughters. She had been a pharmacist at the University of California, Davis for 25 years. Her husband, Ray Ow, works as an engineer for the state government. They are celebrating their 28th anniversary this September.
It’s been a little more than a year since Lee found out about her cancer, but her voice breaks when she talks about that day at the doctor’s office.
“It’s hard to describe how I felt. I can’t even think back on that day…it was a shock, like a nightmare,” she said, her voice interrupted by tears.
At the hospital, Lee called her husband, who was working in southern California at the time.
“You feel as if life has reached its end point and that there is no future. My whole person went numb,” said Ray Ow.
“She told me that she was going to see the doctor that day, but I never thought it would be like this. I took the first flight home, but the hardest part was to wait the two hours at the airport. It was torture. Our lives dramatically changed from there.”
Sitting next to his wife and gazing at her lovingly while she recounted her story, Ray Ow is a gentle-mannered, quiet man. But his love for his wife is clear when he reached over to lightly to rub Lee-Ow’s back, comforting her when she was too sad to speak.
It has been 13 months since her diagnosis. Lee-Ow has already tried three different types of treatment plans. Initially, she underwent chemotherapy and suffered the side effects common to most cancer patients: hair loss, exhaustion, and nausea. But the chemotherapy did not eradicate the cancer cells in her body. Three months later, Lee-Ow received a call from Carol Sill, another patient who had been struggling with lung cancer for six months. Sill told Lee-Ow about a clinical trial at the UC Davis Cancer Center.
“Carol is an angel sent from God,” said Lee-Ow.
“I will forever thank her for that phone call.”
Lee-Ow began participating in a clinical trial for a drug that would control the growth of the cancer cells. But seven months later, the drug stopped working and the cancer spread. In April, Lee-Ow started taking part in another clinical trial for Tarceva, a drug that doctors believe may be especially effective for patients like Lee-Ow, Asian American women who are non-smokers. Tarceva has yet to gain approval from the Food and Drug Administration. It is still too early to tell what kind of effect Tarceva has on Lee-Ow.
“To tell you the truth, I feel that the pain is always getting worse – on my shoulder and my spine. But since some of the pain come and go, it’s hard to say which pain was from cancer,” she said.
“When you have cancer, you feel that everything that hurts in your body is because of it.”
It’s difficult to say why women like Lee-Ow fall victim to lung cancer. Lee-Ow’s father was a smoker, but she had not lived with him for 35 years. Neither her mother nor father had lung cancer.
“We have to stop thinking that lung cancer only happens to smokers,” she said. “Many lung cancer patients are non-smokers so there must be another cause.”
Even though Lee-Ow was born and raised in the United States, she is familiar with why many Chinese Americans still hesitate to talk about cancer, especially lung cancer because of its low survival rate. But Lee-Ow’s family has been by her side through her illness. Ray Ow took early retirement to take care of his wife. He arranges her schedule, cooks, cleans, and is by her side at her doctor’s appointments.
“I just do what I can – I like to cook,” he said. Lee-Ow finished his sentence, “I even gained weight after I got sick. Normally cancer patients will lose weight, but he is always feeding me food,” she said, laughing.
When a family member falls sick, everyone suffers, Lee-Ow said. But she is insistent that she will not live her life by a number like life expectancy.
“No one can deny that when your spouse has cancer, both of you will suffer,” she said. “I’ve always wanted to see my grandchildren graduate from high school, but now, I might not live to see my grandchildren at all,” she said.
“I don’t want to live by numbers. I want to rely on faith and optimism.”
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