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Cisplatin, Mitomycin, and Interferon-2a Combination Chemoimmunotherapy in the Treatment of Diffuse Malignant Pleural Mesothelioma^*

Muzaffer Metintas, MD; Necla Özdemir, MD; rfan Uçgun, MD; Osman Elbek, MD; Mustafa Kolsuz, MD; Sevda Mutlu, MD and Selma Metintas, MD

^* From the Departments of Chest Diseases (Drs. M. Metintas, Özdemir, Uçgun, Elbek, Kolsuz, and Mutlu) and Public Health (Dr. S. Metintas), Osmangazi University Medical Faculty, Eskisehir, Turkey.

Correspondence to: Muzaffer Metintas, MD, Ömeraa mahallesi Adsiz sokak No:11, 26220 Eskisehir, Turkey; e-mail: metintas{at}ada.net.tr

Study objective: To investigate the therapeutic activity and toxicity of combination chemoimmunotherapy with cisplatin, mitomycin, and interferon (IFN)-2a, by comparing the responses in a group of patients with diffuse malignant pleural mesothelioma (DMPM) to the responses in a control group of DMPM patients given supportive care alone.

Design: Patients with histopathologically confirmed DMPM were evaluated for treatment with chemoimmunotherapy.

Setting: After the initial evaluation, all patients received either chemoimmunotherapy or supportive care from the Osmangazi University Medical Faculty, Department of Chest Diseases.

Patients: Forty-three patients with DMPM received chemoimmunotherapy until the end of the survey; 19 patients were given supportive therapy alone after refusing chemoimmunotherapy.

Interventions: Drugs were administered according to the following schedule: IV cisplatin, 30 mg/m² qd on days 1 and 2; IV mitomycin, 8 mg/m² on day 1; and subcutaneous IFN-2a, 4.5 million IU twice weekly. The courses were repeated every 4 weeks.

Results: Overall, 232 chemoimmunotherapy cycles were administered. A total of 10 objective responses (ORs) in 43 patients (23%) were assessed, including 2 complete responses (5%), 4 partial responses, and 4 regressions. Seventeen patients had stable disease, and 16 patients had progression. The median survival time was 11.5 months for the 43 patients who received chemoimmunotherapy and 7.0 months for the 19 patients who received supportive therapy alone. The difference in survival times between the chemoimmunotherapy and supportive therapy groups was not significant. However, the median survival time for the patients who had OR was 21.3 months, which is significantly longer than that of the patients who received supportive care alone and that of patients with progressive disease (6 months). The toxicities associated with the treatment schedule of this study were, for the most part, tolerable.

Conclusions: The drug combination used in this study is moderately effective and well tolerated in patients with DMPM, especially in those who responded to the treatment.

Key Words: chemotherapy • cisplatin • interferon- • mesothelioma • mitomycin • therapy