Post-recurrence chemotherapy for mesothelioma patients undergoing extrapleural pneumonectomy

Our plain-English summary of Post-recurrence chemotherapy for mesothelioma patients undergoing extrapleural pneumonectomy, by T. Takuwa, M. Hashimoto, S. Matsumoto, et al (International Journal of Clinical Oncology, 2017).

The study

• Authors: T. Takuwa, M. Hashimoto, S. Matsumoto, N. Kondo, K. Kuribayash, T. Nakano, S. Hasegawa
• Journal: International Journal of Clinical Oncology
• Published: 2017;22(5):857-864
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Additional chemotherapy is often not feasible in patients with recurrent malignant pleural mesothelioma (MPM) undergoing extrapleural pneumonectomy (EPP), due to deteriorated cardiopulmonary reserve. We thus examined the feasibility and efficacy of additional chemotherapy in patients with recurrent MPM after EPP.

Methods: A retrospective review was conducted of 59 consecutive patients who underwent bi-/tri-modal treatment with induction chemotherapy, EPP, and radiation therapy from July 2004 to August 2013 at Hyogo College of Medicine (Nishinomiya, Japan).

Results: Of 59 patients, 39 (male/female = 31/8, right/left = 15/24, pathological stage I/II/III/IV = 1/7/23/3, bi-/tri-modality = 27/12) relapsed at a median age of 62 (range 37-71) years. The median time to recurrence after EPP was 11.6 months. Of the 39 relapsed patients, 12 received best supportive care alone, six started but discontinued chemotherapy, and the remaining 21 (53%) completed more than three cycles of intravenous chemotherapy. The median survival time after EPP was significantly longer in 21 patients who received additional chemotherapy than in 18 patients who did not (39.2 vs. 12.2 months, P = 0.009).

Conclusions: Additional systemic chemotherapy was successfully administered in more than 50% of relapsed patients after bi-/tri-modal treatment, which included EPP, and resulted in a longer survival in comparison with best supportive care alone.

In plain English

This retrospective study from Hyogo College of Medicine in Japan looked at patients with malignant pleural mesothelioma whose cancer came back after treatment that included extrapleural pneumonectomy (EPP), an operation removing the lung and chest lining. Most patients also had chemotherapy before surgery and radiation afterwards. Of 59 patients treated between 2004 and 2013, 39 had a recurrence, at a median of 11.6 months after surgery. The authors compared 21 patients who completed more than three cycles of further intravenous chemotherapy with 18 who did not. Of those 18, 12 were judged too unwell to start and 6 started but could not finish. Median survival after surgery was 39.2 months in the chemotherapy group versus 12.2 months in the other group (P = 0.009). Median survival after recurrence was 12.8 versus 3.1 months (95% confidence intervals 2.5 to 23.0 and 1.8 to 4.4 months, P = 0.006). The authors concluded that further chemotherapy after recurrence might be both feasible and effective. They cautioned that their data were retrospective and open to patient selection bias, and that patients fit enough for chemotherapy may have had less aggressive tumors.

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 review of medical records at a single institution (patients had been prospectively registered for multimodal treatment)
• Who was studied: 39 patients with recurrent malignant pleural mesothelioma (31 men, 8 women; median age 62, range 37 to 71). They came from 59 consecutive patients who had multimodal treatment including EPP at Hyogo College of Medicine, Nishinomiya, Japan, between January 2004 and August 2013, followed until death or June 2015. The CT group had 21 patients and the No-CT group had 18.
• Exposure: The study did not examine asbestos exposure. What it compared was additional intravenous chemotherapy after recurrence (mostly pemetrexed plus cisplatin or carboplatin, or gemcitabine-based regimens), completed for more than three cycles (CT group), versus incomplete or no additional chemotherapy (No-CT group).
• Main results:
  • Among the 39 patients with recurrence, the median time from EPP to recurrence was 11.6 months (range 1.6 to 96).
  • Of the 39 patients with recurrence, 12 could not receive chemotherapy because of inadequate performance status, and 6 started but could not complete it. These 18 formed the No-CT group.
  • Median survival after EPP was 39.2 months in the CT group (21 patients) versus 12.2 months in the No-CT group (18 patients), P = 0.009. The 1-, 2- and 5-year survival rates were 85.7% vs 50.0%, 49% vs 18.2%, and 31.0% vs 5.6%.
  • Median survival after recurrence was 12.8 months in the CT group (95% CI 2.5 to 23.0) versus 3.1 months in the No-CT group (95% CI 1.8 to 4.4), P = 0.006.
  • For all 39 patients with recurrence, median survival after EPP was 22.0 months (95% CI 13.8 to 30.2) and median survival after recurrence was 6.5 months (95% CI 1.7 to 11.2).
  • The authors reported no statistically significant differences between the CT and No-CT groups in sex, age, pathological stage, histological type or multimodal treatment variables.
• The authors' conclusion: The authors concluded that additional chemotherapy after recurrence following EPP might be both feasible and effective, while noting that its absolute efficacy may not be accurately derived from their data.
• Limitations the authors state:
  • The data set was retrospective and subject to patient selection bias.
  • Patients fit enough for additional chemotherapy might have had tumors with low biological malignancy and slow or minimal relapse.
  • The criteria for deciding who received chemotherapy were incomplete and were often decided patient by patient.

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: Chemotherapy, Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Median Survival.

Related studies

• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• PI3K/mTOR signaling in mesothelioma patients treated with induction chemotherapy followed by extrapleural pneumonectomy — B.K. Bitanihirwe, M. Meerang, et al. (2014)
• The recurrence of malignant pleural mesothelioma 14 years after extrapleural pneumonectomy: possible histological transformation — T. Kinoshita, G. Ishii, et al. (2012)
• Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy — S.C. Kao, S. Klebe, et al. (2011)

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