Maintenance chemotherapy with pemetrexed in patients with malignant pleural mesothelioma – case series and review of the literature

Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. Surgical complete resection, which is the only radical therapy available, is only possible in a minority of patients who suffer from a locally advanced disease. Radiotherapy can be considered as an adjuvant therapy after surgery or as supportive treatment in palliative care. Attempts are also made at combining it with chemotherapy. In cases of locally advanced, non-resectable or metastatic disease, chemotherapy remains the treatment of choice. The most effective palliative chemotherapy is the pemetrexed plus cisplatin regimen. We describe 3 cases of patients who underwent standard palliative chemotherapy with pemetrexed and cisplatin, manifesting good radiological and clinical response, followed by maintenance therapy with pemetrexed. The use of pemetrexed maintenance therapy helped achieve many years of disease control with acceptable toxicity. The consecutive stages of therapy were continuously discussed with our patients, and their informed consent was obtained. Pemetrexed maintenance therapy is not a standard procedure, but recent findings suggest it may be an efficacious option to consider in selected groups of patients. Further randomized prospective studies are needed, but a limiting factor is the rarity of the disease.