Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group

Our plain-English summary of Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group, by J. Remon, E. Nadal, M. Dómine, et al (Lung Cancer, 2020).

The study

• Authors: J. Remon, E. Nadal, M. Dómine, J. Ruffinelli, Y. García, J.C. Pardo, R. López, A. Cilleruelo, R. García-Campelo, P. Martín, O. Juan, J.L. González-Larriba, M. Provencio, E. Olmedo, S. Ponce, D. Cumplido, C. Barenys, M. Majem, B. Massutti, D. Rodriguez-Abreu, R. Porta, M.A. Sala, M. Martinez-Kareaga, P. Lianes, N. Reguart
• Journal: Lung Cancer
• Published: 2020;147:83-90
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant mesothelioma is a rare but aggressive tumor arising from the pleura, typically associated with exposure to asbestos. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and outcomes in Spain.

Material And Methods: Patients diagnosed with malignant mesothelioma of the pleura were recorded in an anonymous online database (BEMME, Epidemiologic Spanish Malignant Mesothelioma Database) from June 2008 through May 2013. Patient and tumor characteristics at time of diagnosis, as well as subsequent treatments (surgery, radiation, and chemotherapy), were collected. Among patients treated with chemotherapy, we explored type of chemotherapy regimen and outcomes by treatments.

Results: A total of 560 malignant pleural mesothelioma (MPM) patients were recorded. The median age at diagnosis was 68 years, mainly with epithelioid histology (62 %), and any asbestos exposure was noted in 45 % of patients. Nearly two-thirds of patients (71 %) received chemotherapy, mainly platinum-pemetrexed combination, as part of their treatment. Surgery and radiotherapy were given in 36 % and 17 % of patients, respectively. The median overall survival (OS) in the whole cohort was 13.0 months (95 % confidence interval (CI), 11.1-14.8 months) with 1-year OS of 53.2 % (95 % CI, 48.7-57.7 %). In patients receiving first-line chemotherapy (N = 315), the median OS was 13.4 months (95 % CI, 10.8-16.0 months), reaching 20.2 months (95 % CI, 17.2-23.2 months) for those 68 patients receiving maintenance chemotherapy. Results of multivariate analyses showed significant association of ECOG-performance status, histology and treatment response with improved OS in MPM patients treated with palliative chemotherapy.

Conclusions: Despite multimodal therapeutic intervention, survival of patients with mesothelioma in Spain remains poor. Although it did not reach significance in the multivariate analysis, a meaningful additional survival benefit was observed among those patients receiving maintenance chemotherapy.

Copyright © 2020 Elsevier B.V. All rights reserved.

In plain English

This was a retrospective review of records from 37 Spanish Lung Cancer Group hospitals. It covered patients newly diagnosed with mesothelioma from June 2008 through May 2013, reporting on the 560 with malignant pleural mesothelioma. Their median age was 68, and 77% were men. Asbestos exposure was reported in 45% of patients; the authors said this was probably underestimated, because no set questionnaire recorded exposure. 71% received chemotherapy, mostly platinum with pemetrexed; 36% had surgery, mostly palliative, and 17% had radiotherapy. Among 519 patients with survival data, median overall survival was 13.0 months (95% CI 11.1-14.8), with estimated survival of 53.2% (95% CI 48.7-57.7%) at 12 months and 28.2% (95% CI 23.9-32.5%) at 24 months. Among 315 patients given palliative chemotherapy, median survival was 13.4 months (95% CI 10.8-16.0). It was 20.2 months (95% CI 17.2-23.2) for the 68 who also received maintenance chemotherapy, but maintenance was not statistically significant in the multivariate analysis. Poorer performance status, non-epithelioid tumor type and disease progressing on chemotherapy were linked to shorter survival. The authors concluded that survival remains poor despite multimodal treatment.

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 multicenter review of clinical records, entered into an anonymous online database (BEMME)
• Who was studied: 604 patients newly diagnosed with mesothelioma at 37 Spanish hospitals affiliated with the Spanish Lung Cancer Group, June 2008 through May 2013. The analysis covered the 560 with malignant pleural mesothelioma (25 peritoneal and 19 other cases were excluded). Median age 68 (range 22-96); 77.1% male.
• Exposure: The study focused on treatments (surgery, radiotherapy, chemotherapy), not on asbestos. Asbestos exposure was reported in 45% of patients (250 of 560, 44.6%; recorded in the table as active 138, passive 41). No fiber types, products, jobs or doses were reported.
• Main results:
  • Survival data were available for 519 patients
  • Whole cohort: median overall survival 13.0 months (95% CI, 11.1-14.8 months)
  • Whole cohort: estimated survival at 12 months 53.2% (95% CI, 48.7-57.7%) and at 24 months 28.2% (95% CI, 23.9-32.5%)
  • Systemic treatment was given to 399 patients (71.3%)
  • Among the 315 patients treated with palliative intent, 272 (86%) received platinum-pemetrexed, with cisplatin the preferred platinum agent
  • Surgery was performed in 204 patients (36.4%), with curative intent in 59 of them
  • 95 patients (17%) received radiotherapy, mostly with palliative intent
  • Median overall survival was 19.2 months in patients who had surgery and 10.6 months in those who did not (p less than 0.001)
  • Whole cohort, multivariable analysis: ECOG performance status, non-epithelioid subtype, metastatic stage (M1), absence of surgery and limited number of chemotherapy lines were significantly associated with shorter survival
  • Patients given palliative chemotherapy: median overall survival 13.4 months (95% CI 10.8-16.0)
  • The 68 patients who received maintenance chemotherapy: median overall survival 20.2 months (95% CI, 17.2-23.2 months)
  • Maintenance treatment and type of platinum agent were associated with survival in the univariate analysis but were not significant in the multivariate analysis
  • Patients given palliative chemotherapy, multivariate analysis: poorer ECOG performance status, non-epithelioid subtype and progressive disease on chemotherapy independently predicted shorter survival
• The authors' conclusion: The authors concluded that, despite multimodal treatment, survival of patients with mesothelioma in Spain remains poor. They wrote that maintenance chemotherapy showed a survival benefit that did not reach significance in the multivariate analysis, and that further prospective data are needed.
• Limitations the authors state:
  • The study was retrospective and had no predefined questionnaire for asbestos exposure or family history of cancer, so these may be underestimated. The authors suggest this may explain why only about half of patients reported asbestos exposure.
  • There was no central pathology review, which may explain the 18% of tumors with unspecified subtype

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Lung Cancer, Malignant Mesothelioma, Pleura, Mesothelioma, Chemotherapy, Epithelioid, Histology.

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• Asbestos-related occupational cancers compensated under the Spanish National Insurance System, 1978-2011 — M. García-Gómez, A. Menéndez-Navarro, et al. (2015)
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