Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare investigation of treatment patterns and overall survival

Our plain-English summary of Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare investigation of treatment patterns and overall survival, by J.L. Beebe-Dimmer, J.P. Fryzek, C.L. Yee, et al (Clinical Epidemiology, 2016).

The study

• Authors: J.L. Beebe-Dimmer, J.P. Fryzek, C.L. Yee, T.B. Dalvi, D.H. Garabrant, A.G. Schwartz, S. Gadgeel
• Journal: Clinical Epidemiology
• Published: 2016;8:743-750
• Cited by: 92 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Mesothelioma is a rare malignancy typically associated with exposure to asbestos and poor survival. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and overall survival (OS) utilizing the National Cancer Institute's Surveillance, Epidemiology, and End Results-Medicare database.

Materials And Methods: Patients in this study were diagnosed with malignant mesothelioma of the pleura or peritoneum between January 1, 2005 and December 31, 2009 with follow-up for survival through December 31, 2010. We examined both patient and tumor characteristics at time of diagnosis and subsequent treatment patterns (surgery, radiation, and chemotherapy). Among patients treated with chemotherapy, we determined chemotherapy regimen and OS by line of therapy.

Results: Of the 1,625 patients considered eligible for this investigation, the median age at diagnosis was 78 years. Nearly a third of patients (30%) had surgery as part of their treatment and 45% were given chemotherapy. The median OS was 8 months (range 1-69 months). Among chemotherapy patients, the most commonly (67%) prescribed regimen for first-line therapy was cisplatin or carboplatin (Ca/Ci) combined with pemetrexed (Pe). Among those prescribed Ca/Ci + Pe as first-line therapy, retreatment with Ca/Ci + Pe (28%) or treatment with gemcitabine (30%) were the most common second-line therapies. Median OS for those receiving first-line chemotherapy was 7 months, and among those receiving second-line therapy median OS was extended an additional 5 months.

Conclusion: Irrespective of surgical resection, mesothelioma patients receiving some form of chemotherapy survived longer than patients who did not, with an additional survival benefit among those patients receiving multimodal treatment.

In plain English

This study used linked U.S. cancer registry (SEER) and Medicare records to describe the treatment and survival of older people with mesothelioma. It included 1,625 patients aged 66 or older, diagnosed from 2005 to 2009 with malignant mesothelioma of the pleura, lung or peritoneum and followed through 2010. It did not measure asbestos exposure. Chemotherapy was given to 727 patients (44.7%). Among chemotherapy patients, the most common first-line regimen combined cisplatin or carboplatin with pemetrexed. It was given to 67.4% of those receiving a single line of chemotherapy. Median survival was 8 months overall, 12 months with chemotherapy and 4 months without. At one year after diagnosis, an estimated 48% (95% CI 45%–52%) of chemotherapy patients and 17% (95% CI 15%–20%) of the others were alive. The estimate was 61% (95% CI 55%–67%) for patients given surgery and chemotherapy, against 42% (95% CI 37%–46%) for chemotherapy without surgery. The authors concluded that patients receiving chemotherapy survived longer, with an added benefit from combined treatment. They cautioned that, because the study was observational, the survival differences may reflect other patient factors.

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: Population-based observational study of treatment patterns and overall survival using the linked SEER–Medicare database
• Who was studied: 1,625 patients aged 66 years and older, diagnosed with primary malignant mesothelioma of the pleura, lung, or peritoneum (including omentum and mesentery) between January 1, 2005 and December 31, 2009 in SEER registry areas of the US, followed for survival through December 31, 2010. Median age at diagnosis was 78 years (range 66–103). The article says 94.2% had malignant pleural mesothelioma.
• Exposure: Asbestos exposure was not measured. The study examined treatments: chemotherapy (mainly cisplatin, carboplatin, pemetrexed and gemcitabine, with vinorelbine used less often), summarized by line of therapy, and therapeutic surgery (performed within 9 months of diagnosis).
• Main results:
  • 727 of the 1,625 patients (44.7%) received some form of chemotherapy.
  • Median overall survival for all patients was 8 months (range 1–69 months).
  • Median overall survival was 12 months (range 1–69) among patients receiving any chemotherapy and 4 months (range 1–69) among patients who did not receive chemotherapy.
  • One-year overall survival was 48% (95% CI 45%–52%) among chemotherapy patients and 17% (95% CI 15%–20%) among those not receiving chemotherapy.
  • One-year overall survival was 61% (95% CI 55%–67%) among patients receiving surgery and chemotherapy and 42% (95% CI 37%–46%) among those receiving chemotherapy without surgery.
  • Among patients receiving one line of chemotherapy, the most common first-line chemotherapy regimen was a platinum-based agent (cisplatin or carboplatin) with pemetrexed (67.4%), followed by pemetrexed alone (22%).
  • Median overall survival measured from the start of first-line chemotherapy was 7 months (range 1–68 months). Measured from the start of second-line chemotherapy, it was 5 months (range 1–33 months).
  • Median overall survival was similar for men (7 months) and women (8 months).
• The authors' conclusion: The authors concluded that mesothelioma patients receiving some form of chemotherapy survived longer than those who did not, regardless of surgery, with an additional survival benefit among patients receiving multimodal treatment.
• Limitations the authors state:
  • Because the study was observational, survival differences are difficult to attribute to the treatment regimen alone and may be explained by other patient-related factors.
  • Comparisons between lines of chemotherapy are affected by survivor bias, because patients had to live long enough to receive a second line.
  • The improvement seen with surgery is difficult to attribute to the surgery itself, because healthier patients make better surgical candidates.
  • Chemotherapy dose is not completely captured in Medicare claims.
  • Retreatment versus maintenance treatment could only be inferred from patterns of therapy.
  • Only Medicare patients were studied, and their average age was higher than that of clinical trial patients.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Epidemiology, SEER, Overall Survival, Pleura, Peritoneum, Chemotherapy, First-line Therapy.

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• Addition of radiotherapy to surgery and chemotherapy improves survival in localized malignant pleural mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) study — A.B. Thompson, T.J. Quinn, et al. (2020)
• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Re: "Mesothelioma trends in the United States: an update based on surveillance, epidemiology, and end results program data for 1973 through 2003" — J.H. Lange (2004)
• Patterns of care and survival among patients with malignant mesothelioma in the United States — L. Enewold, E. Sharon, et al. (2017)
• Frequency of use and predictors of cancer-directed surgery in the management of malignant pleural mesothelioma in a community-based (Surveillance, Epidemiology, and End Results [SEER]) population — R.M. Flores, E. Riedel, et al. (2010)

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