Management options for malignant pleural mesothelioma: clinical and cost considerations

Our plain-English summary of Management options for malignant pleural mesothelioma: clinical and cost considerations, by R.K. Goudar (Drugs, 2007).

The study

• Author: R.K. Goudar
• Journal: Drugs
• Published: 2007;67(8):1149-65
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a resistant form of lung cancer that is often related to prior asbestos exposure. While surgical resection and radiotherapy techniques have been refined in recent years, neither has been proven to significantly extend patient survival compared with untreated controls. Until the release of pemetrexed in 2004, even combination chemotherapy regimens often resulted in a response rate of <20%. A recent phase III trial documented a 41.3% response rate for cisplatin plus pemetrexed. In the future, new multimodality regimens featuring novel targeted therapies directed against molecular targets, such as the vascular endothelial growth factor, hold the greatest promise for improved outcomes in MPM. The standard radiographic assessment of response to MPM therapy remains a poor surrogate for clinically relevant endpoints such as median survival. Furthermore, it is not currently known whether aggressive multimodality treatment for MPM will improve survival or quality of life above and beyond symptomatic care. Ongoing clinical trials are comparing chemotherapy and surgery with supportive care in an effort to define the role of different therapies in MPM. MPM treatment is a costly public health issue; after efficacy is proven, additional studies are needed to measure the cost effectiveness of MPM treatment regimens.

In plain English

This article is a review of treatment options for malignant pleural mesothelioma (MPM), a cancer the author describes as often related to prior asbestos exposure. The author searched the MEDLINE database, with emphasis on review articles, human studies and clinical trials. The review reported that surgery and radiotherapy had not been proven to significantly extend survival compared with untreated controls. In a phase III trial it discussed, comparing pemetrexed plus cisplatin with cisplatin alone, median survival was 12.1 months in the combination group and 9.3 months in the cisplatin-only group (p = 0.02). Final data reported a hazard ratio for death of 0.74 (95% CI 0.60 to 0.90) in the combination group. An FDA review of the imaging confirmed only 47 of the 94 partial responses the trial investigators reported. The review cited a Scottish Medicines Consortium estimate of $US64 080 per quality-adjusted life year for adding pemetrexed to cisplatin. The author concluded that it was not known whether aggressive multimodality treatment improves survival or quality of life beyond symptomatic care, and that cost-effectiveness studies are needed once effectiveness is proven.

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: narrative review of published literature on treatment of malignant pleural mesothelioma, with a short description of practice at Duke University Medical Center
• Who was studied: Published studies of patients with malignant pleural mesothelioma, found by searching MEDLINE (through PubMed and OVID) using 'mesothelioma', with emphasis on review articles, human studies and clinical trials, plus selected abstracts, conference proceedings and references cited in reviewed articles. No search dates or number of included studies are given.
• Exposure: Not an exposure study. The review covers treatments for MPM: surgery, radiotherapy, local therapies, chemotherapy, tyrosine kinase inhibitors, gene therapy and novel agents. It describes MPM as often related to prior asbestos exposure and does not discuss fiber types.
• Main results:
  • The review reported that neither surgical resection nor radiotherapy had been proven to significantly extend patient survival compared with untreated controls.
  • In the cited phase III EMPHACIS trial, median survival was 12.1 months in the pemetrexed plus cisplatin arm and 9.3 months in the cisplatin-only arm (p = 0.02).
  • In the final data from that trial, reported in 2005, the hazard ratio for death in the combination arm was 0.74 (95% CI 0.60 to 0.90; p = 0.003).
  • The trial investigators reported 94 radiographic partial responses in the combination arm. When the FDA independently reviewed the imaging, it confirmed only 47.
  • The review stated that, because published chemotherapy trials had not included an active symptom control arm, it was not yet known whether chemotherapy prolongs survival compared with symptomatic care.
  • According to Scottish Medicines Consortium calculations cited in the review, pemetrexed plus cisplatin would cost $US64 080 per quality-adjusted life year compared with cisplatin alone.
• The authors' conclusion: The author concluded that it is not currently known whether aggressive multimodality treatment for MPM improves survival or quality of life beyond symptomatic care, and that cost-effectiveness studies are needed after efficacy is proven.
• Limitations the authors state:
  • The author noted that different trials cited in the review used different standards to define response, which complicates direct comparison of their results.
  • The author noted that most of the MPM treatment literature consists of single-arm phase II trials measuring radiographic response.

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, Lung Cancer, Asbestos Exposure, Surgical Resection, Pemetrexed (Alimta), Chemotherapy, Cisplatin, Median Survival.

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