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Case 1

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.

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Case 1

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  1. 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

  2. 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

  3. F M E + + Pretreatment After 2 cycles

  4. F M E + + After 2 cycles Pretreatment

  5. 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.

  6. 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).

  7. 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,shehad progressive disease.

  8. A M M + + Pretreatment After 4 cycles

  9. A M M Pretreatment After 4 cycles

  10. AMM Pretreatment

  11. AMM After 4 cycles

  12. 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.

  13. 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.

  14. 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.

  15. M A + Pretreatment

  16. M A After 4 cycles

  17. 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.

  18. 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

  19. 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.

  20. 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 .

  21. M N + + Pretreatment

  22. M N After 2 cycles

  23. M N After 1 year

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