[Case of malignant pleural mesothelioma with long-term disease control after 4 different lines of systemic chemotherapy and pleurodesis].

We report the case of a 68-year-old man with malignant pleural mesothelioma who was successfully treated with 4 lines of systemic chemotherapy and pleurodesis. The diagnosis was made by cytological examination of pleural effusion, using the cell block method for immunochemical staining. The patient received first-line chemotherapy with carboplatin plus gemcitabine, and underwent pleurodesis with carboplatin. This first-line chemotherapy was repeated for 20 cycles, leading to maintained partial regression of the tumor and pleural effusion. After 16 months, recurrence of the tumor with pleural effusion was observed, and single agent vinorelbine as second-line treatment (6 cycles) and single agent gemcitabine as third-line treatment (6 cycles) were administered sequentially. During these periods, diagnostic imaging indicated stable disease or progressive disease, respectively. Fourth-line chemotherapy with cisplatin plus pemetrexed, which was approved in Japan in January 2008, was administered. Pleurodesis with cisplatin was performed at the same time. Partial remission was achieved, but this treatment was stopped after 6 cycles because of renal toxicity limiting further cisplatinum chemotherapy. The overall tumor-control time is more than four years. The patient benefited from outpatient chemotherapy with less severe toxic effects and is alive with a good performance status. It is suggested that combination of several systemic chemotherapy lines and regional disease control such as pleurodesis may be effective for disease control in patients with advanced malignant pleural mesothelioma.