Management of malignant pleural mesothelioma: a French multicenter retrospective study (GFPC 0802 study)

Our plain-English summary of Management of malignant pleural mesothelioma: a French multicenter retrospective study (GFPC 0802 study), by C. Raynaud, L. Greillier, J. Mazieres, et al (BMC Cancer, 2015).

The study

• Authors: C. Raynaud, L. Greillier, J. Mazieres, I. Monnet, B. Mastroianni, G. Robinet, G. Fraboulet, A. Dixmier, H. Berard, R. Lamy, J. Letreut, H. Lena, G. Oliviero, S. Botta, A. Vergnenegre, I. Borget, C. Chouaid
• Journal: BMC Cancer
• Published: 2015;15:857
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare disease with poor prognosis in spite of significant improvement in survival, due to new chemotherapy regimens. We describe here patients' profiles and management in daily practice in France.

Methods: Observational retrospective study. Data were collected from medical files. All patients with histologically proven MPM diagnosed from January 2005 to December 2008 were included in the participating sites.

Results: Four hundred and six patients were included in 37 sites: mean age 68.9 ± 9.8 years, male predominance (sex ratio 3.27), latency of the disease 45.7 years, epithelioïd type 83 %. Diagnosis was made using thoracoscopy in 80.8 % of patients. Radical surgery was performed in 6.2 % of cases. Chemotherapy was administered to 74.6 % of patients. First line regimens consisted mainly of platinum + pemetrexed (91 %) or pemetrexed alone (7 %). Objective response rate was 17.2 % and another 41.6 % of patients experienced disease stabilization. Half of these patients underwent second line chemotherapy (platinium + pemetrexed 31.6 %, pemetrexed alone 24.6 %), resulting in a 6 % response rate. Third-line chemotherapy (56 patients) yielded disease control in 5.4 % of cases.

Conclusions: The management of MPM in France is usually in accordance with guidelines. Response rates are somewhat lower than those described in clinical trials.

In plain English

This French study reviewed medical files of 406 patients with malignant pleural mesothelioma diagnosed from January 2005 to December 2008 at 37 sites. It described patients and care, without statistical tests. The mean age at diagnosis was 68.9 years, and 76.6% were men. Asbestos exposure was identified in 259 patients (63.8%), almost all through work (251), with a mean of 45.7 years from exposure to diagnosis. Most diagnoses came from surgical thoracoscopic biopsy (78.1%); 82.9% of tumors were epithelioid. Thirty patients had surgery aimed at cure. Of 303 patients given first-line chemotherapy, 9 had a complete response, 43 a partial response, and 178 (58.8%) disease control. Second-line disease control was listed for 41 of 162 patients and printed as 24.6%, though the table's counts add up to more than 162. Third-line disease control was 3 of 56 (5.4%). The authors concluded that care in France was in line with European recommendations, but outcomes were usually lower in routine practice than in clinical trials. They noted that responses were judged locally without central review and survival was not measured.

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: Observational retrospective multicenter study based on review of medical files, using descriptive statistics only
• Who was studied: 406 patients with histologically proven malignant pleural mesothelioma diagnosed between January 2005 and December 2008. They were managed at 37 sites in France belonging to the GFPC (French Group of Onco-Pneumology): 16 teaching hospitals, 18 general hospitals, 2 cancer research centers and 1 military hospital. Mean age at diagnosis was 68.9 years (SD 9.8), and 76.6% were men.
• Exposure: Asbestos exposure was assessed by a specific questionnaire and identified in 259 of 406 patients (63.8%): professional in 251 (96.9%) and environmental in 8 (3.1%). Mean time from exposure to diagnosis was 45.7 years. No fiber types are given.
• Main results:
  • Surgical thoracoscopic biopsy was the diagnostic procedure in 317 of 406 patients (78.1%).
  • Tumor type: epithelioid 82.9%, sarcomatoid 10%, mixed or biphasic 7.1%.
  • 30 patients had curative surgery (25 extra-pleural pneumonectomy, 5 pleurectomy). In addition, 191 had pleurodesis.
  • 268 patients received prophylactic drain-site radiation therapy. The authors noted this is not recommended in guidelines.
  • First-line chemotherapy was given to 303 patients (74.6%). Of these, 162 (53.5%) went on to second-line and 56 (18.5%) to third-line chemotherapy.
  • According to the results section, the most frequently used regimens were cisplatin plus pemetrexed in first line and gemcitabine alone in second and third line. The discussion states that 91% of first-line regimens were platinum plus pemetrexed.
  • First line (n = 303): complete response 9 (3.0%), partial response 43 (14.2%), stable disease 126 (41.6%), disease control 178 (58.8%), progression 99 (32.7%).
  • Second line (n = 162): complete response 1, partial response 9, stable disease 31, and disease control 41, printed as 24.6%. The table's second-line outcome counts (1 + 9 + 31 + 78 + 48) add up to 167, not 162, and 41 of 162 would be 25.3%. The discussion gives a 6% response rate.
  • Third line (n = 56): partial response 1 (1.8%), stable disease 2 (3.6%), disease control 3 (5.4%), progression 27 (48.2%).
• The authors' conclusion: The authors concluded that management of malignant pleural mesothelioma in France is in line with European recommendations, but that treatment outcomes remain disappointing and are usually lower in routine practice than in clinical trials.
• Limitations the authors state:
  • There was no centralized review of response to treatment, and patient follow-up was not standardized.
  • Some data were missing because they are not systematically recorded in routine practice.
  • Survival curves could not be established because longitudinal data were not collected.
  • The cohort represents only about 10% of all patients diagnosed and treated in France.
  • Age at first asbestos exposure was not recorded in the patients' files.

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, Prognosis, Chemotherapy, Latency, Thoracoscopy, Pemetrexed (Alimta), Clinical Trial.

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• Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma — A. Scherpereel, French Speaking Society for Chest Medicine (SPLF) Experts Group (2007)
• Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients — P. Bovolato, C. Casadio, et al. (2014)
• Second-line chemotherapy in malignant pleural mesothelioma: results of a retrospective multicenter survey — P.A. Zucali, M. Simonelli, et al. (2012)
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