Chemotherapy of malignant pleural mesothelioma unresectable was approved in Europe in 2004. This combination of cisplatin to a new multi-target antifolate, pemetrexed (Alimta), improves length and quality of survival. In monotherapy, Alimta is indicated as second line treatment of lung cancer in non-small cell.
Malignant pleural mesothelioma (MPM), said Dr. P. Ruffié (IGR, Villejuif), has long been a kind of orphan disease without treatment. It is mainly caused by exposure to asbestos while also discussing the role of genetic predisposition, ionizing radiation, some viruses. Its incidence increased by 25% every three years because of its development time (latency from thirty to forty years), the worst is yet to come: a peak of incidence is planned for 2020.

Late diagnosis.

Occupational diseases related to asbestos are underreported (25%) as the industries concerned, they could be underway to relocate in the world. The diagnosis is delayed (98% of cases) at a time when surgery and radiotherapy are not possible, the prognosis is poor, little changed by different chemo-and radiotherapy isolated tried so far. The median survival of epithelioid MPM (68% of MPM) is ten to seventeen months in the absence of any treatment, which means that half the patients died within this period, the sarcomatous MPM is resistant to treatment ( survival of four to seven months). However, the prognosis depends on the patient profile: respiratory pain, anemia, leukocytosis and increased platelet elements are pejorative. Treatment received a European marketing authorization in September 2004: pemetrexed (Alimta) in combination with cisplatin is indicated for patients with unresectable MPM not received previous chemotherapy. Its objective is to enable the patient to survive as long as possible under the best conditions. Alimta is an analogue of folic acid, which inhibits three multi-target folate-dependent enzymes essential for cell replication. Cisplatin is an anticancer reference in the treatment of thoracic tumors, the combination works synergistically to block the replication of DNA tumor. One study (N. Vogelzang et al., “Journal of Clinical Oncology, 2003) compared the efficacy of combined than cisplatin alone. The results show a clear superiority of the association: response of 41% of patients (17% cons), median survival twelve months (nine months): half of patients gained three months of extra life “which may seem very little but at this late stage, it is a good result “said Dr Ruffié; half of patients still alive one year after diagnosis with a significant improvement in lung function and symptoms (pain, shortness of breath).

Lung cancer non small cell.

Alimta is indicated as monotherapy in second-line treatment of lung cancer in non-small cell (NSCLC: 80% of lung cancers) with locally advanced or metastatic. In this context, a study (N. Hanna et al., “JCO, 2004) compared Alimta to docetaxel monotherapy. Three out of four patients were at an advanced stage (IV or metastatic), all had relapsed after chemotherapy. The aim was not cure patients, said Dr. T. Knight (IGR Villejuif), but a survival benefit in the best conditions, whereas previously only the palliative care were considered. The median overall survival was “compares favorably” to that of docetaxel (8.3 and 7.9 months); again, the results may seem small, but there are only ten years, we did not second-line treatment , patients are already dead.
The toxicity profile of Alimta is more favorable than leukopenia (5.3% against 40.2%) inparticular less febrile neutropenia, fewer hospitalizations for side effects, use of growth factors very expensive, less alopecia. Vomiting, fatigue, nausea are comparable. Supplementation with folic acid and vitamin B12 required Alimta (500 mg/m2 body surface area) is administered by venous infusion (peripheral vein) of ten minutes on the first day of each cycle of 21 days. Supplementation with folic acid (from 0.350 to 1 mg daily) and oral vitamin B12 (1 000 mcg every nine weeks) by intramuscular route is necessary. With dexamethasone 4 mg morning and evening is administered orally, the day before and day after infusion. Vitamin supplementation is usually very appreciated by the patient since a cancer patient on two would (also) use of alternative medicine. It is essential to reduce the toxicity, the patient can receive up to six cycles, which improves efficiency.

Each progress as infimme be it in research is a step forward. We must learn from the cancer plan: we are the European country which treats the most cancers, and whoever has the most deaths from cancer. The cause of this: the lack of early detection due to lack of prevention. Today medicine has TDM equipment (scanner) very powerful so that it could reverse the trend by discovering native tumors before they grow and metastasize. For this, it would take at least that people know they have been exposed to asbestos, a scanner and go consult a pulmonologist.