Case 1
FME 45 ys old female housewife from Helwan.
At presentation ( 8/10/2003), she was complaining
of pain in the chest and dyspnea of 4 month
duration.
CT chest revealed right pleural effusion associated
with complete collapse of the middle and lower
right lung lobes,enlarged mediastinal lymph node.
Pleural biopsy: malignant mesothelioma mixed
type
Received Pemetrexed plus Cisplatin for 6cycles
started in 17/11/2003 every 21 days.
CT evaluation after 2nd cycle showed partial
remission.
At the end of treatment :
Still partial remission , duration of response more
than 17 months.
Toxicity: vomiting grade I, edema
FME
+
+
Pretreatment After 2 cycles
FME
+ +
Pretreatment After 2 cycles
Case 2
AMM 40 ys old female housewife from Giza.
At presentation ( 8/11/2003), she was complaining
of cough and dyspnea of 3 month duration.
CT chest revealed:
right pleural thickening and effusion.
Multiple small hepatic focal lesions.
Thoracoscopic Pleural biopsy: malignant
mesothelioma epithelial type, low grade.
Received Pemetrexed plus Cisplatin for 6 cycles
started in 7/12/2003 ended in 19/4/2004.
CT evaluation after 4 cycles (21/03/2004)
Partial remission, duration of response (10
months).
After the last cycle, she developed GII
peripheral neuropathy in the form of numbness
in both lower limbs and tinnitus in Lt ear.
The patient was kept under FU till
6/10/2004,she had progressive disease.
AM M
+
+
Pretreatment After 4 cycles
AM M
Pretreatment After 4 cycles
AMM
Pretreatment
AMM
After 4 cycles
Case 3
MAA 55 ys old male, non smoker, from
Alexandria.
In 3/2003 CT chest revealed:
right pleural thickening and effusion with Rt lower
lobe mass.
Minor thoracotomy & Pleural biopsy: malignant
mesothelioma epithelial type.
Received Vepesid plus Cisplatin for 6 cycles
with progressive disease.
Received Navelbine plus Adriamycine for 3
cycles with progressive disease.
Presented to the Institute 8/2003 with dyspnea,
cough and chest pain so the patient received
Pemetrexed plus Cisplatin for 6 cycles started
in 1/9/2003 every 21 days.
CT evaluation after 4 cycles revealed
marvelous therapeutic response .The patient
was kept under FU for 7 months, he had
progressive disease on 3/8/2004
Duration of response 11 months.
The patient developed skin rash after 2nd cycle
improved with antihistaminic and decadrone,
transient elevated liver enzymes and diarrhea
grade I.
MA
+
Pretreatment
MA
After 4 cycles
Case 4
MNA, 67y old diabetic male patient , non
smoker, living in Helmiat EL zaitoon , Cairo .
At presentation in 1/3/2004, he had shortness
of breath ,progressive exertional dyspnea of 3
months duration, associated with left chest pain
and cough.
CT examination of the Chest :
Left pleural effusion and thickening, sub
segmental atelectasis and partial relaxation
collapse of left lower lobe.
Small left upper pulmonary nodules.
Pleural Biopsy :
Biphasic malignant pleural mesothelioma
8/3/2004 the patient received the first cycle of
chemotherapy after premedication with Folic Acid ,
and Vitamin B12 .
Chemotherapy Pemetrexed plus Cisplatin, for 2
courses .
After 2 cycles , CT chest 12/4/2004 ----- Partial
Regression of pleural thickening , effusion and lung
nodules ( PR ) .
Patient continued therapy for 8 courses , ended
18/8/2004 , with marked regression of the pleural
mass.
After 7th cycle the patient developed G2 sensory
neuropathy of both hands and feet , which regressed
with supportive therapy within 2 weeks .
After 8th cycle, 18/8/2004 , the patient was kept
under follow up with CT of the chest every 3 months.
Maintained PR for 12 months, till 8/2005 the patient
had progressive disease , Bone Scan showed
increased uptake over upper dorsal vertebrae .
MN
+
+
Pretreatment
MN
After 2 cycles
MN
After 1 year