Second-line gemcitabine-based chemotherapy regimens improve overall 3-year survival rate in patients with malignant pleural mesothelioma: a multicenter retrospective study

Our plain-English summary of Second-line gemcitabine-based chemotherapy regimens improve overall 3-year survival rate in patients with malignant pleural mesothelioma: a multicenter retrospective study, by H. Mutlu, S. Gündüz, H. Karaca, et al (Medical Oncology, 2014).

The study

• Authors: H. Mutlu, S. Gündüz, H. Karaca, A. Büyükçelik, Y.B. Cihan, A. Erden, Z. Akca, H.S. Coşkun
• Journal: Medical Oncology
• Published: 2014;31(8):74
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In the present study, we aimed to evaluate the effectiveness of second-line gemcitabine-based chemotherapy regimens on overall survival (OS) in malignant pleural mesothelioma (MPM) patients receiving first-line pemetrexed-based regimens. A total of 73 patients with MPM from Akdeniz University, Acibadem Kayseri Hospital, Kayseri Training and Research Hospital, and Erciyes University were analyzed and evaluated retrospectively as two groups: second-line gemcitabine-based chemotherapy and no second-line chemotherapy. The median OS of patients who received second-line gemcitabine-based chemotherapy was 11.3 (5.1-17.5) months, while it was 9.9 (2.1-17.7) months in the patients who did not receive chemotherapy in the second-line setting (p = 0.056). When we evaluated the survival rate at the 6th, 12th, 18th, 24th, and 36th month, the OS rate of the 36th month was significantly higher in patients who received gemcitabine-based second-line chemotherapy (p = 0.041). When evaluating the OS from diagnosis to death, the median OS values were 20.8 (17.5-24.1) months for first-line pemetrexed-based regimens then second-line gemcitabine alone and 13.1 (9.0-17.1) months supportive care after first-line pemetrexed-based regimens (p = 0.005). According to our results, we may consider gemcitabine-based regimens as second-line chemotherapy after treatment with pemetrexed plus platinum in patients with MPM.

In plain English

This multicenter retrospective study reviewed hospital records from 2003 to 2013 at four Turkish hospitals. It covered 73 patients with malignant pleural mesothelioma, all first treated with platinum plus pemetrexed. Afterward, 33 received second-line gemcitabine-based chemotherapy and 40 received supportive care only. Asbestos exposure was not reported. The gemcitabine group was significantly younger (mean age 56.4 versus 62.3 years). Survival was timed from the start of gemcitabine, or from first progression for patients given no second-line chemotherapy. Median survival was 11.3 (5.1 to 17.5) months with gemcitabine and 9.9 (2.1 to 17.7) months with supportive care, a difference that was not statistically significant (p = 0.056). At 36 months, survival was 14.3% with gemcitabine and 0% with supportive care (p = 0.041). Differences at 6, 12, 18 and 24 months were not significant. Measured from diagnosis, median survival was 20.8 (17.5 to 24.1) months with gemcitabine versus 13.1 (9.0 to 17.1) months with supportive care (p = 0.005). The authors concluded gemcitabine-based regimens may be considered as second-line treatment after pemetrexed plus platinum. The authors did not state limitations.

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: multicenter retrospective study of hospital records comparing two treatment groups
• Who was studied: 73 patients with malignant pleural mesothelioma (MPM) treated at four hospitals in Turkey, with records from 2003 to 2013. All had received first-line platinum plus pemetrexed chemotherapy. Most were stage 4 (27 of 33 in the gemcitabine group, 36 of 40 in the supportive-care group).
• Exposure: The study looked at treatment, not asbestos exposure. After first-line platinum plus pemetrexed, 33 patients received second-line gemcitabine-based chemotherapy and 40 received no second-line chemotherapy (supportive care). Asbestos exposure and fiber types are not reported.
• Main results:
  • Patients in the gemcitabine group were significantly younger than those in the supportive-care group (mean age 56.4 versus 62.3 years, p = 0.014). Sex, stage and pathologic subtype did not differ significantly between the groups.
  • Overall survival was measured differently in the two groups. For patients given second-line gemcitabine, it ran from the start of that treatment. For patients given no second-line chemotherapy (who had received first-line chemotherapy), it ran from first progression after first-line chemotherapy.
  • Median overall survival was 11.3 (5.1 to 17.5) months in the gemcitabine group and 9.9 (2.1 to 17.7) months in the supportive-care group. The difference was not statistically significant (p = 0.056).
  • The 36-month overall survival rate was 14.3% in the gemcitabine group and 0% in the supportive-care group (p = 0.041). Table 2 shows no significant difference at 6, 12, 18 or 24 months (p = 0.130, 0.660, 0.106 and 0.413).
  • Measured from diagnosis to death, median overall survival was 20.8 (17.5 to 24.1) months for patients who received pemetrexed plus platinum followed by gemcitabine. It was 13.1 (9.0 to 17.1) months for patients who received pemetrexed plus platinum followed by supportive care (p = 0.005).
• The authors' conclusion: The authors concluded that gemcitabine-based regimens may be considered as second-line chemotherapy after pemetrexed plus platinum in patients with malignant pleural mesothelioma. They described the treatment as improving the overall 3-year survival rate.

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: Gemcitabine, Chemotherapy, Pleural Mesothelioma, Overall Survival, Pemetrexed (Alimta), Second-Line Therapy.

Related studies

• Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy — G. Toyokawa, M. Takenoyama, et al. (2014)
• Second-line chemotherapy in malignant pleural mesothelioma: results of a retrospective multicenter survey — P.A. Zucali, M. Simonelli, et al. (2012)
• Switch-maintenance gemcitabine after first-line chemotherapy in patients with malignant mesothelioma (NVALT19): an investigator-initiated, randomised, open-label, phase 2 trial — C.J. de Gooijer, V. van der Noort, et al. (2021)
• Chemotherapy management of malignant pleural mesothelioma: a phase II study comparing two popular chemotherapy regimens — E.E. Habib, E.S. Fahmy (2013)
• Gemcitabine with or without ramucirumab as second-line treatment for malignant pleural mesothelioma (RAMES): a randomised, double-blind, placebo-controlled, phase 2 trial — C. Pinto, P.A. Zucali, et al. (2021)
• Vinorelbine and gemcitabine as second- or third-line therapy for malignant pleural mesothelioma — M.G. Zauderer, S.L. Kass, et al. (2014)

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