The Efficacy Of Pemetrexed And Bevacizumab Intrapleural Injection For Malignant Pleural Mesothelioma-Mediated Malignant Pleural Effusion.

e18545 Background: To evaluate the efficacy of pemetrexed chemotherapy combined with intrapleural injection of pemetrexed and bevacizumab in the treatment of malignant pleural mesothelioma(MPM)-mediated malignant pleural effusion, and analyze the objective response rate (ORR), the median progression free survival (PFS) and the median overall survival (OS). Methods: We analyzed the clinical data of 23 MPM patients with pleural effusion who was treated with a combination chemotherapy of pemetrexed at 500mg/m2, on day 1 plus cisplatin (DDP) at 20mg/m2 on day 1-5 of each 21 day cycle, and concurrently, intrapleural injection of pemetrexed 0.5g and bevacizumab 300mg was administered on day 3 or day 4 after complete effusion drainage. ELISA test was applied to detect the vascular endothelial growth factor (VEGF) level in the pleural effusion and serum, and assess the objective response rate and survival. Results: In the 23 evaluable patients, the VEGF level in the pleural effusion and serum was significantly decreased, P < 0.01, pleural effusion of 20 patients (86.96%) was controlled effectively. There were 8 complete responses, 7 partial responses, 5 stable disease and 3 progressive disease, the ORR was 65.21%, the DCR was 86.96%, the median PFS was 6 months, the median OS was 14.5 months, and the one-year survival rate was 41.22%. Toxicities were generally mild and manageable, the major toxicities included myelosuppression, fatigue and anemia, mainly were grade 1-2 which could be managed by symptomatic treatments. Conclusions: The combination of pemetrexed chemotherapy with intrapleural injection of pemetrexed and bevacizumab is efficacious and safe for MPM pleural effusion, and results of the present study demonstrate some improvement in the PFS and OS. The expression of VEGF in the pleural effusion and serum plays a guiding role in monitoring the efficacy of bevacizumab in the treatment of malignant pleural effusion.