Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma

Our plain-English summary of Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma, by M. Mencoboni, R.A. Filiberti, P. Taveggia, et al (Oncology Research and Treatment, 2017).

The study

• Authors: M. Mencoboni, R.A. Filiberti, P. Taveggia, F. Grosso, G. Pasello, L. Del Corso, A. Muzio, V. Polo, P. Zucali, G.L. Ceresoli, H.J. Soto Parra, L. Auriati, C. Simonassi
• Journal: Oncology Research and Treatment
• Published: 2017;40(6):364-369
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma is a problematic condition due to poor prognosis and difficulties in management. We evaluated the treatment and outcome of 378 mesothelioma patients referred to 6 Italian Oncology Departments.

Methods: Demographic and clinical data were collected. Treatment was assessed in terms of chemotherapy (line of treatment, pemetrexed-based regimen, other therapies), surgery, and radiotherapy. Response to therapy, progression-free survival, and overall survival were evaluated.

Results: 36 and 342 patients received best supportive care and active treatment, respectively; 86 patients underwent surgery, and 26 received trimodal therapy. Disease control after first-line chemotherapy was achieved in 74.2% of patients (75.7% in patients treated with pemetrexed combined with other drugs and 69% with pemetrexed as monotherapy). The disease control rate was 82.6% in pemetrexed re-challenged individuals. Median survival time was 11.6 months with supportive care, 16.2 months with chemotherapy only, 32.4 months with surgery plus chemotherapy, and 47.2 months with trimodal therapy. A more favorable prognosis was observed in responders to first-line therapy who were then actively treated with second-line (24.8 vs. 11.8 months in non-responders, p < 0.001) and third-line chemotherapy (28.9 vs. 17.8 months in non-responders, p = 0.005).

Conclusion: Mesothelioma patients benefited from chemotherapy alone only when retreated in the second line after response to first-line therapy.

© 2017 S. Karger GmbH, Freiburg.

In plain English

This retrospective study reviewed records of 378 malignant pleural mesothelioma patients at 6 Italian oncology departments, 2002 to 2014. It examined treatment and survival, not asbestos exposure. Thirty-six patients received best supportive care (9 also had radiotherapy), 256 chemotherapy without surgery, 60 surgery with chemotherapy, and 26 surgery, chemotherapy and radiotherapy (trimodal therapy). After first-line chemotherapy alone, disease shrank or stayed stable in 181 of 244 patients with data (74.2%). Median survival from diagnosis, with 95% confidence intervals, was 18.7 months (16.3 to 21.1) overall, 11.6 (7.2 to 15.9) with supportive care, 16.2 (14.6 to 17.8) with chemotherapy alone, 32.4 (24.1 to 40.7) with surgery plus chemotherapy and 47.2 (37.5 to 56.9) with trimodal therapy. Patients whose disease shrank or stayed stable on first-line treatment and then had second-line chemotherapy survived a median 24.8 months (95% CI 21.2 to 28.3), versus 11.8 months (8.0 to 15.6) if disease had progressed. The authors said patient selection influenced outcomes and the supportive-care group was too small for conclusions. They concluded that chemotherapy alone helped only when patients were retreated after responding to first-line therapy.

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: Retrospective review of clinical records (multicenter case series of patients seen in daily practice)
• Who was studied: 378 patients with malignant pleural mesothelioma referred to 6 Italian oncology departments, March 2002 to January 2014; median age 69.6 years, 74.3% male, 78.8% epithelioid
• Exposure: The study did not examine asbestos exposure. It examined treatments: best supportive care (36 patients, 9 of whom also received radiotherapy), chemotherapy (first to third line, mostly pemetrexed-based), surgery (pleurectomy/decortication or extrapleural pneumonectomy) and radiotherapy
• Main results:
  • 36 patients received best supportive care, and 9 of them received radiotherapy
  • Among patients treated with first-line chemotherapy only and with response data (244 of 256), disease control was achieved in 181 (74.2%)
  • Disease control after second-line therapy: 67 of 129 patients with data (51.9%); 82.6% in patients re-challenged with pemetrexed
  • Overall median progression-free survival for the whole group was 10.2 months (95% CI 9.0 to 11.5)
  • Median overall survival for all 378 patients was 18.7 months (95% CI 16.3 to 21.1); overall survival was measured from diagnosis
  • 73 patients (19.3%) survived more than 3 years
  • Median overall survival was 32.4 months (95% CI 24.1 to 40.7) for patients with surgery plus chemotherapy and 47.2 months (95% CI 37.5 to 56.9) for those with trimodal therapy
  • Among patients without surgery, median overall survival was 11.6 months (95% CI 7.2 to 15.9) with best supportive care and 16.2 months (95% CI 14.6 to 17.8) with first-line chemotherapy; the authors described this as no large difference
  • Patients who responded to first-line therapy and then had second-line chemotherapy had median survival of 24.8 months (95% CI 21.2 to 28.3), compared with 11.8 months (95% CI 8.0 to 15.6) in non-responders, p less than 0.001. With third-line chemotherapy the figures were 28.9 months (95% CI 22.4 to 35.4) vs 17.8 months (95% CI 14.8 to 20.9), p = 0.007. The study counted stable disease as a response, and survival was measured from diagnosis
  • Patients re-challenged with pemetrexed had median survival of 45.6 months (95% CI 33.1 to 58.1), compared with 15.1 months (95% CI 13.2 to 16.9) for all other patients, p less than 0.001
  • In multivariate analysis, three factors were independent negative prognostic factors for survival: mixed/sarcomatous morphology (HR 1.53, 95% CI 1.09 to 2.17), ECOG performance status 2 (HR 2.12, 95% CI 1.16 to 3.88) and high LDH (HR 1.44, 95% CI 1.07 to 1.93)
  • In the same multivariate model, active chemotherapy in non-surgical patients was associated with lower survival (HR 1.53, 95% CI 1.03 to 2.26, p = 0.034). In that model, each therapy was compared against best supportive care
• The authors' conclusion: The authors concluded that chemotherapy might be ineffective in the first-line setting, and that patients benefited from chemotherapy alone only when retreated in the second line after a positive response to first-line therapy
• Limitations the authors state:
  • The number of patients receiving best supportive care was too low to draw a conclusion
  • The group treated first-line with chemotherapy other than pemetrexed was very small (n = 16)
  • Pemetrexed re-challenge was given to patients with sensitive cancers and long progression-free survival
  • The selection of patients for each type of therapy (for example by age and histology) influenced the outcomes

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Mesothelioma, Chemotherapy, Pemetrexed (Alimta), Progression-Free Survival, Overall Survival, Median Survival.

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