Effect of induction chemotherapy on lung function and exercise capacity in patients affected by malignant pleural mesothelioma

Our plain-English summary of Effect of induction chemotherapy on lung function and exercise capacity in patients affected by malignant pleural mesothelioma, by G. Marulli, F. Rea, S. Nicotra, et al (European Journal of Cardio-thoracic Surgery, 2010).

The study

• Authors: G. Marulli, F. Rea, S. Nicotra, A.G. Favaretto, E. Perissinotto, M. Chizzolini, A. Vianello, F. Braccioni
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2010;37(6):1464-9
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: The effect of induction chemotherapy (IC) on lung function and exercise capacity in patients with malignant pleural mesothelioma (MPM) has not been largely examined. The aim of this study was to evaluate the changes in pulmonary function and oxygen consumption following IC in patients with MPM.

Methods: Between 2004 and 2009, 36 consecutive patients (mean age 62.1 + or - 1.5 years, M/F = 25/11) were prospectively investigated. Data concerning medical history, histology, staging and response to chemotherapy were collected. All patients underwent pulmonary function test before (in the absence of pleural effusion) and after chemotherapy (platinum-based agent plus pemetrexed); 23 out of 36 patients also performed a cardiopulmonary incremental exercise test.

Results: An epithelioid histotype was documented in 88.8% of patients. A partial response to chemotherapy was observed in 44.5% of cases and 36.1% of patients experienced grade 2-3 toxicity. A significant improvement in forced expiratory volume in 1s (FEV(1)) (0.13 + or - 0.30 l; P = 0.01), in VO(2) peak (1.76 + or - 2.91 ml kg(-1) min(-1); P = 0.005), in PaO(2) at rest (4.76 + or - 9.84 mmHg; P = 0.03) and in PaO(2) at peak exercise (6.26 + or - 12.72 mmHg; P = 0.04) was detected. The diffusion capacity of the lung for carbon monoxide (DLCO) also increased (1.25 + or - 4.68 ml min(-1) mmHg(-1)), although not significantly (P = 0.20). The stratified analysis based on the response to IC showed a significant improvement in FEV(1), forced vital capacity (FVC) and vital capacity (VC) (both absolute and percentage of predicted values) only in patients with a partial response.

Conclusions: An improvement in lung function and exercise capacity was seen after IC in patients with MPM. These data suggest that IC does not compromise cardiopulmonary performance in this subset of patients.

Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

In plain English

This prospective study at the University of Padua, Italy, followed 36 consecutive patients with stage I to III malignant pleural mesothelioma, enrolled between March 2004 and March 2009. Thirty of the 36 had asbestos exposure: 23 occupational and 7 environmental. All received three cycles of induction chemotherapy, meaning chemotherapy given before planned surgery. The drugs were pemetrexed with cisplatin or carboplatin. All patients had lung function tests before and after chemotherapy, and 23 also did an exercise test. Sixteen patients (44.5%) had a partial tumour response, 17 had stable disease and three progressed. After chemotherapy, the authors found statistically significant improvements in FEV1, the air breathed out in one second (P = 0.01). Blood oxygen levels at rest and at peak exercise also improved significantly, as did peak oxygen uptake (P = 0.005). A gas-transfer measure (DLCO) rose, but not significantly (P = 0.20). Gains in FEV1, FVC and VC were significant only in partial responders. The authors concluded that induction chemotherapy did not appear to compromise cardiopulmonary performance. They noted that the small number of patients needs confirmation in a larger sample.

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: Prospective study of consecutive patients, comparing lung function and exercise tests before and after induction chemotherapy
• Who was studied: 36 consecutive patients with stage I to III malignant pleural mesothelioma, treated at the Cardio-Thoracic and Vascular Sciences Department, University of Padua, Italy, from March 2004 to March 2009. There were 25 men and 11 women, with a mean age of 62.1 years. 30 patients (83.4%) had asbestos exposure: 23 occupational and 7 environmental. 6 patients had no asbestos exposure.
• Exposure: The exposure studied was induction chemotherapy: pemetrexed 500 mg per square metre plus cisplatin 75 mg per square metre or carboplatin AUC5, given every 3 weeks for three cycles. Asbestos exposure was recorded, but no fiber types were named.
• Main results:
  • All 36 patients had spirometry before and after chemotherapy. 23 of the 36 also performed a cardiopulmonary exercise test.
  • Response to chemotherapy among the 36 patients: 16 (44.5%) had a partial response, 17 (47.2%) had stable disease and 3 (8.3%) progressed.
  • Grade 3 haematological toxicity occurred in 6 patients (16.7%) and grade 3 non-haematological toxicity in 2 patients (5.5%).
  • In the whole group, FEV1 improved significantly after chemotherapy, by a mean of 0.13 litres (SD 0.30; P = 0.01).
  • Arterial oxygen (PaO2) improved significantly: by a mean of 4.76 mmHg at rest (SD 9.84; P = 0.03) and by 6.26 mmHg at peak exercise (SD 12.72; P = 0.04).
  • Peak oxygen uptake (VO2 peak) improved significantly, by a mean of 1.76 ml per kg per minute (SD 2.91; P = 0.005).
  • DLCO increased by a mean of 1.25 ml per minute per mmHg (SD 4.68), but the change was not statistically significant (P = 0.20).
  • When patients were analysed by response, FEV1, FVC and VC improved significantly only in the 16 patients with a partial response. Their mean increase ranged from 15% to 20%.
  • The two chemotherapy protocols (carboplatin plus pemetrexed in 19 patients, cisplatin plus pemetrexed in 17) did not differ in toxicity or in radiological response.
• The authors' conclusion: The authors concluded that induction chemotherapy does not compromise cardiopulmonary performance in patients with malignant pleural mesothelioma. They added that it seems not to increase the risk of cardiopulmonary complications for surgery.
• Limitations the authors state:
  • The relatively small number of patients means the findings need confirmation in a larger sample.
  • Improvement on the diseased side could mask a possible harmful effect of chemotherapy on the other lung.
  • No ventilation/perfusion lung scan was done before and after chemotherapy, so the two sides could not be assessed separately.
  • In the conference discussion, the author acknowledged a possible bias related to pleural effusion and the timing of the first lung function test.

Topics

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

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Histology, Staging, Pulmonary Function Test (PFT), Pleural Effusion, Pemetrexed (Alimta), Epithelioid.

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