A Review of Pharmacologic Management in the Treatment of Mesothelioma

Our plain-English summary of A Review of Pharmacologic Management in the Treatment of Mesothelioma, by E.P. Borrelli, C.G. McGladrigan (Current Treatment Options in Oncology, 2021).

The study

• Authors: E.P. Borrelli, C.G. McGladrigan
• Journal: Current Treatment Options in Oncology
• Published: 2021;22(2):14
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma is a rare and severe form of cancer that is associated with asbestos exposure. Approximately 2500 Americans die annually from this condition with a median survival of 1 year. The latency period of this disease ranges anywhere from 20 to 70 years, with shorter latency periods associated with a higher exposure intensity to asbestos. Therefore, cases of mesothelioma are expected in the coming decades. This highlights the need for clinicians to understand the pharmacologic regimens available for treating this rare, yet serious malignancy. With multiple treatment regimens available in the treatment of this condition, clinicians should take an evidence-based approach and consider the totality of evidence and safety information while considering the best patient-centered approach for treatment. This article provides a review of current pharmacologic treatment options available for mesothelioma and goes into detail about the recommended medication regimens and dosages and the available evidence of efficacy, effectiveness, and/or safety and estimates the annual cost of treatment for these medications on the U.S. healthcare system per patient. A brief introduction is provided for several promising agents currently under investigation for mesothelioma as well.

In plain English

This article is a review, not a new study of patients. The authors reviewed treatment guidelines and published research on recommended mesothelioma drug regimens. For each regimen they summarized dosing, earlier study findings, and an estimated U.S. drug cost per patient. Cost estimates assumed a typical male cancer patient weighing 72 kg and 6 cycles or up to 24 weeks of treatment, and covered the drugs only. The article names two pricing sources: Medicare average sale prices for July 2020 plus 6% in its Methods, and 2020 wholesale acquisition costs in its main table. Estimates ranged from about $515 for 24 weeks of vinorelbine to about $46,225 for six cycles of pemetrexed plus cisplatin, $101,132 with bevacizumab added, and $153,800 for four cycles of ipilimumab plus nivolumab. One phase III trial they reviewed reported median overall survival of 12.1 months (95% confidence interval 10.0 to 14.4) with pemetrexed plus cisplatin versus 9.3 months (interval 7.8 to 10.7) with cisplatin alone. The authors also briefly described drugs still under investigation. They concluded that the treatment landscape will likely continue to change.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of treatment guidelines and published literature on drug treatments for mesothelioma, with the authors' own estimates of U.S. drug costs per patient, plus a targeted (non-exhaustive) review of drugs in development
• Who was studied: Patients with mesothelioma (mostly malignant pleural mesothelioma) in previously published trials and guidelines. Cost estimates were modeled for a typical male cancer patient with a mean weight of 72 kg and a body surface area of 1.91 m^2.
• Exposure: Drug treatments for mesothelioma, not asbestos exposure: pemetrexed with cisplatin or carboplatin (with or without bevacizumab or durvalumab), pemetrexed alone, gemcitabine plus cisplatin, vinorelbine, ipilimumab plus nivolumab, and pembrolizumab. Asbestos is mentioned only as background.
• Main results:
  • Authors' estimated drug cost for six cycles of pemetrexed plus cisplatin: $46,225
  • Authors' estimated drug cost for six cycles of pemetrexed plus carboplatin: approximately $46,231
  • Authors' estimated cost for six cycles of pemetrexed and cisplatin with bevacizumab: $101,132
  • Authors' estimated cost for 6 cycles of the durvalumab combination: $100,990.44 to $101,032.44, depending on the platinum drug used
  • Authors' estimated cost for gemcitabine plus cisplatin: approximately $187.08 per cycle and $1122 for six cycles
  • Authors' estimated cost for 24 weeks of vinorelbine: $515
  • Authors' estimated cost for four cycles of ipilimumab plus nivolumab: approximately $153,800
  • Authors' estimated cost for 24 weeks (8 treatments) of pembrolizumab: approximately $86,372
  • From an earlier phase III trial the review describes, not this article's own data: median overall survival was 12.1 months (95% CI 10.0 to 14.4) with pemetrexed plus cisplatin versus 9.3 months (95% CI 7.8 to 10.7) with cisplatin alone, p = 0.020
  • From an earlier phase III trial the review describes, in previously untreated adults: median overall survival was 18.1 months with nivolumab plus ipilimumab versus 14.1 months with platinum doublet chemotherapy (HR 0.74, 95% CI 0.61 to 0.89)
• The authors' conclusion: The authors concluded that, because of the long latency period, patients will continue to present with mesothelioma, and that the treatment landscape will likely continue to change as new agents and evidence emerge.
• Limitations the authors state:
  • Cost estimates cover only the medications, not the cost of giving them or of managing side effects
  • The review of drugs in development was targeted, not exhaustive
  • The cost-effectiveness analyses of pemetrexed with cisplatin that the authors cite are over a decade old, when drug prices were different
  • Surgery and radiation were outside the scope of the review and were described only briefly

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Median Overall Survival, Latency.

Related studies

• Combined chemotherapy with cytotoxic and targeted compounds for the management of human malignant pleural mesothelioma — R.E. Favoni, T. Florio (2011)
• Future developments in the management of malignant pleural mesothelioma — P.A. Zucali, F. De Vincenzo, et al. (2009)
• Current trends in the management of malignant peritoneal mesothelioma — J.T. Miura, F.M. Johnston, et al. (2014)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Second-line treatment for malignant pleural mesothelioma — G.L. Ceresoli, P.A. Zucali, et al. (2010)
• Review on clinical trials of targeted treatments in malignant mesothelioma — J.N. Jakobsen, J.B. Sørensen (2011)

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