Life after first-line chemotherapy in malignant pleural mesothelioma: a North-East England experience

Our plain-English summary of Life after first-line chemotherapy in malignant pleural mesothelioma: a North-East England experience, by J. Steer, G. Bough, A.R. Razak, et al (Clinical Oncology, 2010).

The study

• Authors: J. Steer, G. Bough, A.R. Razak, G.J. Meachery, A. Hughes
• Journal: Clinical Oncology
• Published: 2010;22(3):231-5
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: The benefit of first-line chemotherapy in malignant pleural mesothelioma (MPM) has been established. However, this disease invariably progresses and little is known about how this disease subsequently relapses after initial treatment. Data on second-line treatment are also scarce, especially outside the context of a clinical trial. We conducted a review to observe the presentation of MPM patients when their disease progresses after initial therapy and the use of second-line therapy and its associated outcomes.

Materials And Methods: Patients were retrospectively identified from the Sunderland Royal Hospital and the Northern Centre for Cancer Care, Newcastle upon Tyne, UK. Data, including demographics, clinical presentation and treatment details at first line and beyond, together with its associated benefits, were collected. Related times to treatment failure (TTF), rates of symptom improvement and survival data were also collated.

Results: There were 62 evaluable patients in our series. At the time of data collection, 58 patients (94%) had relapsed. At disease progression, symptoms were usually similar to those at initial presentation, but in patients with prolonged TTF (>9 months) they were more likely to relapse with clinical lymphadenopathy in the neck and axilla compared with patients with TTF < or =9 months (52% vs 13%, respectively, P<0.05). Second-line treatment was given in 45% of patients. Twenty-one patients (36%) received second-line chemotherapy outside the context of a clinical trial and most had retreatment with pemetrexed-based chemotherapy due to a prolonged TTF. In patients treated with second-line therapy outside the remit of a clinical trial, a disease control rate was achieved in nine patients (43%, 95% confidence interval 22-64), whereas improvement in symptoms were noted in 13 patients (62%, 95% confidence interval 41-83). The median TTF in this setting was 6.5 months.

Conclusion: Patients with a prolonged TTF after first-line treatment are more likely to relapse with neck and axillary lymphadenopathy. The use of second-line chemotherapy, including rechallenge treatment, in this disease is a viable option for a selected group of MPM patients.

Copyright 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

In plain English

This retrospective study reviewed records of malignant pleural mesothelioma patients given first-line chemotherapy from 1998 to 2008 at two hospitals in Sunderland and Newcastle upon Tyne, UK. Of 65 patients identified, 62 had notes available. The study did not examine asbestos exposure. Most patients (50 of 62) first received pemetrexed with carboplatin or cisplatin. Disease control was seen in 45 patients (73%, 95% confidence interval 61–84). By the time data were collected, 58 (94%) had treatment failure, with a median time to treatment failure of 8.1 months. Enlarged lymph nodes in the neck or armpit at relapse occurred in 52% of patients whose time to treatment failure exceeded 9 months, compared with 13% of those with shorter times. Twenty-one patients received second-line chemotherapy outside a clinical trial, mostly pemetrexed again. Disease control occurred in nine of them (43%, 95% confidence interval 22–64). Symptoms improved in 13 (62%, 95% confidence interval 41–83). This figure was counted across all 21 patients, although symptom data were available for only 19. Median overall survival was 14 months. The authors concluded that second-line chemotherapy is a viable option for selected patients. They noted that the study did not address quality of life.

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 observational study (review of patient records)
• Who was studied: 65 patients treated with first-line chemotherapy for malignant pleural mesothelioma between 1 January 1998 and 31 December 2008 at Sunderland Royal Hospital and the Northern Centre for Cancer Care, Newcastle upon Tyne, UK; clinical data were available for 62 (53 male, 9 female; median age 62)
• Exposure: The study did not examine asbestos exposure. It studied chemotherapy: first-line treatment was mostly pemetrexed with carboplatin or cisplatin (50 of 62 patients), followed in some patients by second-line chemotherapy.
• Main results:
  • After first-line chemotherapy, disease control was seen in 45 of 62 patients (73%, 95% confidence interval 61–84).
  • After first-line chemotherapy, clinical improvement was seen in 38 patients (61%, 95% confidence interval 49–73, intention to treat analysis). Data on clinical response were available for 56 patients.
  • 58 patients (94%) had experienced treatment failure after first-line treatment. The median time to treatment failure was 8.1 months.
  • 52% of patients with a time to treatment failure of more than 9 months relapsed with lymph node enlargement in the neck and/or axilla, compared with 13% of patients with a shorter time to treatment failure (P less than 0.05).
  • 21 patients (36%) received second-line chemotherapy outside a clinical trial. Of these, 19 received a pemetrexed–platinum regimen, and 18 were classed as retreatment with pemetrexed.
  • Among the 21 patients given second-line chemotherapy outside a trial, disease control was achieved in nine (43%, 95% confidence interval 22–64).
  • Among the 21 patients given second-line chemotherapy outside a trial, clinical improvement was documented in 13 (62%, 95% confidence interval 41–83, intention to treat analysis). Data on clinical benefit were available for 19 of the 21.
  • The median time to treatment failure after second-line treatment was 6.5 months.
  • Median overall survival for the 62-patient cohort was 14 months.
• The authors' conclusion: The authors concluded that patients with a prolonged time to treatment failure after first-line treatment are more likely to relapse with neck and axillary lymph node enlargement. They also concluded that second-line chemotherapy, including rechallenge treatment, is a viable option for a selected group of patients with malignant pleural mesothelioma.
• Limitations the authors state:
  • The authors stated that the study does not answer quality-of-life questions about second-line treatment, because of its retrospective design.

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, Clinical Trial, Second-Line Therapy, Disease Progression, Lymphadenopathy, Pemetrexed (Alimta), confidence interval.

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