NabPC May Be Alternative to Standard Mesothelioma Chemotherapy

Mesothelioma that can’t be treated with surgery or radiation is usually then fought with chemotherapy. The mesothelioma chemotherapy formulation employed first and foremost is cisplatin with pemetrexed.

This drug combination does a good job of lengthening mesothelioma survival. Certainly that’s true for many mesothelioma patients.

But there are some who cannot tolerate the mixing of cisplatin and pemetrexed. As a result, mesothelioma chemotherapy for them is not an option.

It should be an option, though. Mesothelioma researchers are determined to make sure that it is. They have been trying to find other chemotherapy drug combinations these patients can take instead.

One team of scientists in Japan sees a glimmer of hope in using nanoparticle albumin-bound paclitaxel plus carboplatin — nabPC for short — as an alternative to standard mesothelioma chemotherapy.

Writing in a recent edition of the journal Respirology Case Reports, the researchers said they observed good results with nabPC in a mesothelioma patient who was intolerant of the conventional cisplatin-pemetrexed cocktail.

Good news, yes. Unfortunately, the researchers tried this mesothelioma chemotherapy alternative on only one person. So the favorable results can only be considered anecdotal.

Still, this lone case study from Kyoto Medical Center is worth pondering. It might even spur researchers elsewhere to conduct a large-scale clinical trial necessary of nabPC.

Diagnosed with Epithelioid Malignant Pleural Mesothelioma

The researchers’ story begins with a 76-year-old man who showed up one day at Kyoto Medical Center to complain of severe fever and pain in the right side of his chest.

During the medical workup of this patient, it was revealed that he had been exposed to asbestos earlier in his life. That helped explain the pleural effusions detected by an X-ray of his right lower lung lobe.

A CT scan afterward showed a buildup of interlobular septal nodules and pleural thickening. A month later the researchers performed a video-assisted thoracoscopy and pleural biopsy.

The lab results that came back showed he was suffering from epithelioid malignant pleural mesothelioma.

A radiology scan combining positron emission tomography with CT revealed several tumors growing in the man’s lymph nodes. When all was said and done, they diagnosed him at Stage IV mesothelioma.

That made him ineligible for surgery or radiation therapy or both. Instead they started him on standard chemotherapy. Follow-up imaging studies showed this wasn’t working.

So the researchers decided to try him on nabPC. This involved administering carboplatin at a rate of 6 mg/mL per minute on the first day only and 100 mg/m2 of paclitaxel on days 1, 8 and 15.

This regimen was repeated every four weeks. Follow-up work showed a drastic decrease in interlobular nodules. Pleural thickness also was reduced.

Mesothelioma Chemotherapy Restarted

However, the researchers had to stop the chemotherapy after the fourth cycle. The problem was that the patient suffered from peripheral sensory neuropathy and the paclitaxel was making it worse.

But despite having to stop, the nabPC halted the mesothelioma for five months. That encouraged the researchers to take a chance on restarting the nabPC chemotherapy regimen two months later.

The researchers gave the same doses as before. It was again effective. But, just as happened the previous time, they had to stop after the fourth cycle because of the neuropathy problem.

“To the best of our knowledge, this is the first case report of treatment with nabPC repetitively achieving effective tumor regression in [malignant pleural mesothelioma],” the researchers wrote.

“The present case suggests that nabPC is a potential alternative chemotherapy agent,” they added. “Further prospective studies regarding the efficacy of nabPC in MPM patients should be conducted.”

The title of the article is “Repetitive Responses to Nanoparticle Albumin-Bound Paclitaxel and Carboplatin in Malignant Pleural Mesothelioma.”