Population-based survival for malignant mesothelioma after introduction of novel chemotherapy

Our plain-English summary of Population-based survival for malignant mesothelioma after introduction of novel chemotherapy, by R.A. Damhuis, C. Schroten, J.A. Burgers (The European Respiratory Journal, 2012).

The study

• Authors: R.A. Damhuis, C. Schroten, J.A. Burgers
• Journal: The European Respiratory Journal
• Published: 2012;40(1):185-9
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is known for its dismal prognosis and poor response to conventional treatment. Chemotherapy with cisplatin-antifolate combinations recently showed promising response rates and prolonged survival in randomised trials. To assess the impact of this development on clinical practice and survival at a population-based level, treatment patterns and survival trends were studied for patients diagnosed with mesothelioma in the period 1995-2006. 4,731 records were retrieved from the Netherlands Cancer Registry and chemotherapy use and median survival were analysed. For the periods 1995-1998 to 2005-2006, chemotherapy use increased from 8% to 36%. Median survival increased over time from 7.1 months to 9.2 months. For pleural mesothelioma, multivariable analysis demonstrated that survival was poorer for elderly patients and sarcomatoid tumours. The prognostic impact of chemotherapy increased with time. Median survival for chemotherapy treated patients improved from 10.1 months (1995-1998) to 13.1 months (2005-2006). For peritoneal mesothelioma, median survival was poor (3.9 months) but better for females and younger patients. This study demonstrates that chemotherapy use increased at a national level and coincided with an improvement in survival. The novel chemotherapy regimen appears to be more effective but, due to the observational nature of this study, alternative explanations cannot be excluded.

In plain English

This study used records from the Netherlands Cancer Registry to see how often people with malignant mesothelioma received chemotherapy, and how long they survived, after newer antifolate–platinum chemotherapy came into use. It included 4,731 patients diagnosed from 1995 through 2006: 4,464 with pleural and 267 with peritoneal mesothelioma. Chemotherapy use rose from 8% of patients in 1995–1998 to 36% in 2005–2006, and it was given much less often to older patients. Median survival for all patients rose from 7.1 to 9.2 months. Among patients given chemotherapy, median survival rose from 10.1 to 13.3 months, while survival did not change over time for patients without recorded initial chemotherapy. Median survival was 8.1 months for pleural and 3.9 months for peritoneal mesothelioma. For pleural mesothelioma, older age and sarcomatoid tumours were linked to shorter survival. The authors concluded that mesothelioma is still a fatal disease. Because the study was observational and lacked information on disease extent and patients' fitness, they said it cannot reliably show that chemotherapy worked. Other explanations, such as better palliative care or earlier diagnosis, were possible.

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 national cancer registry records (survival and treatment-pattern analysis)
• Who was studied: 4,731 patients with malignant mesothelioma (4,115 males, 616 females; median age 68) diagnosed 1995 through 2006 and recorded in the Netherlands National Cancer Registry. Of these, 4,464 had pleural and 267 had peritoneal mesothelioma. Follow-up ran to January 1, 2009.
• Exposure: Initial chemotherapy treatment (yes or no), compared across diagnosis periods. The novel antifolate–platinum regimen was introduced in 2003–2004. The type of chemotherapy was known only for the Rotterdam region subset. Surgery and radiotherapy were recorded but ignored in the analyses. Asbestos exposure was not measured.
• Main results:
  • Among all patients, chemotherapy use rose from 8% in 1995–1998 to 36% in 2005–2006 (OR 8.4).
  • Older patients received chemotherapy less often: 11% of those aged 70–79 (OR 0.22) and 3% of those aged 80 or over (OR 0.04).
  • For all patients, median survival rose over time from 7.1 to 9.2 months. The authors described this as presumably related to the new chemotherapy regimen.
  • Median survival was 8.1 months for pleural mesothelioma and 3.9 months for peritoneal mesothelioma.
  • By tumour type, median survival was 3.6 months for sarcomatoid, 7.1 months for mixed and 10.1 months for epithelioid tumours.
  • Median survival was 5.2 months for patients aged 80 or over, compared with 10.5 months for those aged 20–59.
  • For patients who received chemotherapy, median survival rose from 10.1 months (1995–1998) to 13.3 months (2005–2006). Overall 2-year survival was 13%.
  • For pleural mesothelioma, multivariable analysis found age, tumour type and chemotherapy to be independent prognostic factors. The chemotherapy risk ratio was 0.99 (0.81–1.21) in 1995–1998 and 0.64 (0.56–0.73) in 2005–2006. Survival for patients who did not receive chemotherapy did not change over time (p = 0.23).
  • For peritoneal mesothelioma, only sex and age were significant. Females had a risk ratio of 0.61 (95% CI 0.45–0.84). Tumour type, period and chemotherapy were not statistically significant.
• The authors' conclusion: The authors concluded that, despite the new chemotherapy regimens, malignant mesothelioma is still a fatal disease with a median survival under 1 year. They said chemotherapy appeared to become more effective over time, but that its effectiveness cannot be reliably judged from an observational study.
• Limitations the authors state:
  • Observational data cannot reliably show chemotherapy efficacy. Missing information on extent of disease and performance status may cause residual confounding.
  • Immortal time bias: chemotherapy patients cannot die before their first cycle, giving them a survival head start.
  • Alternative explanations for the survival increase, such as better palliative care or earlier diagnosis, could not be ruled out.
  • Stage information was not used because there was no standard staging policy.
  • The type of chemotherapy was known only for the Rotterdam subset (under 20% of cases).
  • Only initial treatment was recorded, so actual chemotherapy use may have been higher than recorded.
  • The effect of age on survival may be confounded by differences in stage at diagnosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Chemotherapy, Prognosis, Cisplatin, Antifolate, Mesothelioma, Cancer Registry, Median Survival.

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