Activity of pemetrexed in recurrent, metastatic sacral chordoma: A case report

Abstract

Chordomas are a rare slow growing tumor with a high recurrence rate that originate from residual embryonic notochord cells, primarily affecting the axial skeleton. Currently limited treatment options exist beyond surgery and radiation, and systemic chemotherapy has shown limited efficacy. The majority of chordomas exhibit negative thymidylate synthase (TS) expression, implying a potential responsiveness to the antifolate agent pemetrexed. We present a case report of a 78-year-old patient with recurrent, metastatic sacral chordoma who showed clinical and radiological improvement with pemetrexed treatment. The patient received 12 cycles of pemetrexed which resulted in a decrease in the size of liver and lung lesions. Moreover, the patient experienced resolution of debilitating symptoms, including right leg weakness, and unsteady gait. This case report highlights the use of pemetrexed as a therapeutic option for recurrent and metastatic chordoma. Further research is warranted to explore the optimal use of pemetrexed in chordoma management and identify predictive biomarkers for treatment response.