E. Campagnoli

The "old drug" DTIC as a second/third line chemotherapy in advanced soft tissue sarcomas (STS)

9032 Background: There is not a standard second line chemotherapy in advanced STS. DTIC is one of the most active drugs in the treatment of STS with a response rate (RR) of 17%. As a second line chemotherapy the data available confirm these interesting results. Therefore we conducted a retrospective analysis about 44 patients (pts) treated in our Institute with DTIC as second/third line therapy between May 1997 and October 2003. The aim of our analysis was to evaluate the RR, the progression free survival (PFS) and the median duration of response. METHODS About 44 pts anlysed, 36 were evaluable; 8 pts, after first cycle, were treated elsewhere. The median age was 55,5 (range 24-75). The 75% of pts (27/36) were metastatic and the 72% (26/36) had a disease grading 2-3. DTIC was done as second line chemotherapy in 70% of pts(25/36). The 75% of pts (27/36) and the 25% (9/36) had respectively progressive and relapsed disease before to start the treatment. DTIC was given every 21 days with three different schedules: DTIC 800 mg/sqm day 1 (20 pts); DTIC 400 mg/sqm days 1 and 2 (6 pts); DTIC 300 mg/sqm days 1, 2 and 3 (10 pts). RESULTS Among 36 evaluable pts, 3 (8%) achieved partial response (PR) and 7 (19%) stable disease (SD), with an overall disease control of 28%. No complete response was observed. As second line therapy DTIC achieved 2/25 PR and 5/25 SD. The median PFS and the median duration of response were respectively 2 and 8 months. The progression free rate at 3 and 6 months was respectively 33% (SE 7.86%) and 25% (SE 7.2%). No grade 3-4 hematologic and non-hematologic toxicity according to W.H.O. was observed. CONCLUSIONS Our results suggest that DTIC as a second/third line therapy yields a satisfactory disease control in progressive STS; its activity seems to be comparable to other treatments, such as the high dose of ifosfamide or ET-743, but with a lower toxicity profile. The increse of dose-intensity to obtain a better RR is questionable considering cost-benefit ratio in terms of toxicities and overall survival. No significant financial relationships to disclose.

80 Early response evaluation in malignant pleural mesothelioma by positron emission tomography with 18F-fluorodeoxyglucose

PURPOSE Response evaluation with conventional criteria based on computed tomography (CT) is particularly challenging in malignant pleural mesothelioma (MPM) due to its diffuse pattern of growth. There is growing evidence that therapy-induced changes in tumor [(18)F]fluorodeoxyglucose (FDG) uptake as measured by positron emission tomography (PET) may predict response and patient outcome early in the course of treatment. PATIENTS AND METHODS Patients with histologically proven MPM, not candidates to curative surgery, scheduled to undergo palliative chemotherapy with a pemetrexed-based regimen were eligible for this study. Patients were evaluated by FDG-PET and CT at baseline and after two cycles of therapy. A decrease of 25% or more in tumor FDG uptake as measured by standardized uptake value was defined as a metabolic response (MR). Best overall response from CT scans was determined according to previously published criteria. RESULTS Twenty-two patients were included in the study, and 20 were assessable for early metabolic response with FDG-PET. Of these, eight were classified as responders (40%) and 12 as nonresponders (60%). Early MR was significantly correlated to median time-to-tumor progression (TTP) with a median TTP for metabolic responders of 14 months versus 7 months for nonresponders (P = .02). No correlation was found between TTP and radiologic response evaluated by CT. Patients with a MR had a trend toward longer overall survival. CONCLUSION The use of MR evaluated by FDG-PET in the assessment of treatment efficacy in MPM appears promising. Our observations need to be validated in a larger prospective series.