Turkish Journal of Geriatrics 2010 , Vol 13, Issue 3
Onur TURAN1, Ahu YALABIK2, Emine OSMA3, Aydanur KARGI4, Atila AKKOÇLU1
1Dokuz Eylül Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı İZMİR
2Özel Menemen Hastanesi Göğüs Hastalıkları Bölümü İZMİR
3Dokuz Eylül Üniversitesi Tıp Fakültesi Radiodiagnostik Anabilim Dalı İZMİR
4Dokuz Eylül Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı İZMİR
Malignant mesothelioma is a highly aggressive kind of tumour with a poor prognosis and a limited response to chemotherapy. Pemetrexed disodium, a multi-targeted antimetabolite inhibiting folate pathway, has demonstrated promising clinical activity in a wide variety of solid tumours including mesothelioma. An 81-year-old female patient was admitted to our hospital because of cough and dyspnea. Unilateral right-sided massive pleural effusion and multiple pleural nodules were determined by thorax CT. Mesothelioma was diagnosed by an open lung biopsy. As chemotherapy could be toxic for an elderly patient, radiotherapy was administered. After an asymptomatic follow-up period of 18 months, a new TCT revealed multiple pleural nodules, massive pleural effusion, mediastinal lymph nodes with pathological sizes and a subcutaneous mass, which was interpreted as progression of the primary tumour. We decided to administer chemotherapy containing pemetrexed and cisplatin at tolerable doses. After the chemotherapy, the patient was evaluated with TCT, which revealed that, subcutaneous mass had disappeared and mediastinal lymph nodes and pleural nodules had dramatically regressed. As is known, studies on chemotherapy for treatment of malign mesothelioma are not very promising. This case, with a dramatic tumour response is presented to show that pemetrexed can be an effective and favorable chemotherapeutic agent for mesothelioma treatment, even in elderly patients. Keywords : Mesothelioma/drug therapy; Pemetrexed; Cisplatin; Aged; Treatment outcome