Pemetrexed and its emerging role in the treatment of thoracic malignancies

Emerging therapeutic options for Philadelphia-positive acute lymphocytic leukemia

Acute lymphocytic leukemia (ALL) is a heterogeneous group of disorders that are associated with a cure rate of > 80% in children. The prognosis in adults is considerably inferior, with age, disease bulk, leukemia karyotype and immune phenotype being prognostically relevant. Adult ALL treatment programs include induction, intensified consolidation and maintenance phases with CNS prophylaxis. The addition of imatinib in patients with BCR-ABL-positive ALL has improved the prognosis of this subgroup, but their survival is still poor. Initial data on the second-generation BCR-ABL inhibitors, dasatinib and nilotinib, indicate a potentially greater efficacy than imatinib, but the improvement is likely to be modest. The overall efforts in terms of developmental therapeutics in ALL are very modest and not in keeping with the urgent need for improvement. Most agents being investigated have mechanisms of action similar to those of existing agents for ALL therapy and thus represent modest opportunities to improve results. Of such agents, data on BCR-ABL inhibitors, sphingosomal vincristine, pemetrexed, talotrexin, annamycin and ABT-751 are reviewed.

[Surgery for malignant pleural mesothelioma]

Malignant pleural mesothelioma (MPM) is an aggressive cancer of the pleura that is usually caused by exposure to asbestos. The incidence of MPM has risen for some decades and is expected to peak between 2010 and 2020. Current surgical treatment involves in a multimodality regimen with radiation and multiple-drug chemotherapy. All currently proposed therapeutic strategies are in total agreement with the international Mesothelioma Interest Group TNM staging system. Schematically: for stage Ia (early stage disease), the therapeutic approach is generally neo-adjuvant intrapleural treatment using cytikines followed by surgical pleurectomy; for more advanced disease (stage Ib, II and III), a multimodal treatment combining extra-pleural pneumonectomy, radiotherapy and multiple-drug chemotherapy, including in all cases cisplatin, is proposed. Recently, results using this multiple modality approach have been favorable especially for patients with epithelial histology, negative resection margins and no metastases to extrapleural lymph nodes; for stage IV (unresectable tumor), palliative treatment is indicated. Early results have been encouraging and the use of recent drugs should allow more optimal treatment.