Systemic treatment in patients with malignant pleural mesothelioma - real life experience

Our plain-English summary of Systemic treatment in patients with malignant pleural mesothelioma - real life experience, by B. Ziółkowska, B. Cybulska-Stopa, D. Papantoniou, et al (BMC Cancer, 2022).

The study

• Authors: B. Ziółkowska, B. Cybulska-Stopa, D. Papantoniou, R. Suwiński
• Journal: BMC Cancer
• Published: 2022;22(1):432
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare, aggressive malignancy of the pleural cavity linked to asbestos exposure. The combination of pemetrexed and platinum is a standard first-line therapy for malignant pleural mesothelioma. Despite some progress, almost all MPM patients experience progression after first-line therapy. The second-line treatment is still being under discussion and there are very limited data available on the second-line and subsequent treatments.

Methods: The retrospective analysis included 57 patients (16 females and 41 males) from two Polish oncological institutions treated for advanced mesothelioma between 2013 and 2019. We analysed the efficacy of first-line and second-line therapy: progression-free survival (PFS), overall survival (OS), overall response rate (ORR).

Results: In the first-line treatment, 55 patients received pemetrexed-based chemotherapy (PBC) and two cisplatin in monotherapy. Patients' characteristics at baseline: median age was 64.2 years, ECOG PS ≤ 1 (86.2%), epithelial histology (85.7%). Median PFS and OS were 7.6 months and 14 months, respectively. Patients with ECOG PS ≤ 1 vs > 1 had a longer median OS (14.8 months vs 9.7 months, p = 0.057). One-year OS and PFS were 60.9% and 32.0%, respectively. Disease control rate (DCR) was 82.5%. Response to first-line therapy: PFS ≥ 6 months and PFS ≥ 12 months had a significant impact on median OS. Twelve patients received second-line therapy (seven PBC and five other cytotoxic single agents: navelbine, gemcitabine, or adriamycin/vincristine/methotrexate triplet). Median PFS and OS were 3.7 months and 7.2 months, respectively. DCR was 83%. One-year OS and PFS were 37% and 16.7%, respectively. In the group receiving PBC, OS was prolonged by 4.5 months compared to the non-PBC group (6.0 months vs 10.5 months, p = 0.47).

Conclusion: Patients who benefited from first-line therapy and had prolonged PFS at first-line and achieve PFS longer than 6 months at first-line should be offered second-line treatment. Consideration of retreatment with the same cytotoxic agent could to be a viable option when no other treatment are available.

© 2022. The Author(s).

In plain English

This retrospective study reviewed records of patients with malignant pleural mesothelioma treated at two Polish cancer institutes between 2013 and 2019. Of 164 patients, 57 had received first-line chemotherapy and were analysed. Of these, 55 received pemetrexed-based chemotherapy and two received cisplatin alone. After first-line treatment, median progression-free survival was 7.6 months and median overall survival was 14 months. At one year, 60.9% of patients were alive and 32.0% were free of progression. Patients whose first-line progression-free survival lasted 6 months or more had a significantly longer median overall survival than those under 6 months. Of the 50 patients whose disease progressed, 12 received second-line treatment: seven were retreated with pemetrexed-based chemotherapy and five received other drugs. For these 12, median progression-free survival was 3.7 months and median overall survival was 7.2 months. Differences between pemetrexed-based and other second-line treatments were not statistically significant. No treatment-related deaths were reported. The authors concluded that patients who benefit from first-line therapy and achieve progression-free survival longer than 6 months should be offered second-line treatment. They noted the study was retrospective and small.

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 analysis of hospital records (two-centre case series of treated patients)
• Who was studied: 57 patients (16 females, 41 males; median age 64.2 years) with malignant pleural mesothelioma who received first-line systemic therapy at two branches (Gliwice and Cracow) of the Maria Sklodowska-Curie National Research Institute of Oncology, Poland, 2013 to 2019. They were selected from 164 patients.
• Exposure: The study examined chemotherapy, not asbestos exposure; patients' asbestos exposure was not reported. First-line treatment was pemetrexed-based chemotherapy in 55 patients (48 pemetrexed plus platinum, 7 pemetrexed alone) and single-agent cisplatin in 2. Second-line treatment was pemetrexed-based retreatment in 7 patients, or gemcitabine (2), vinorelbine (2), or adriamycin/vincristine/methotrexate (1).
• Main results:
  • First-line, all 57 patients: median progression-free survival 7.6 months (range 0 to 98 months); median overall survival 14 months (range 0 to 140 months).
  • First-line: one-year overall survival 60.9% and one-year progression-free survival 32.0%. Disease control rate was 82.5%. 20 patients (35.1%) responded (1 complete, 19 partial) and 27 (47.4%) had stable disease.
  • First-line: median overall survival was 14.8 months for patients with ECOG performance status 1 or lower versus 9.7 months for those above 1 (p = 0.057, above the study's 0.05 significance threshold).
  • By first-line progression-free survival: median overall survival was 10.5 months with PFS of 6 months or more versus 3.2 months with PFS under 6 months (p = 0.0039). It was 41.2 versus 6.0 months for PFS of 12 months or more versus under 12 months (p = 0.039).
  • First-line side effects were mainly grade 1 or 2: anaemia 25%, neutropenia 13%, fatigue 12%. Grade 3 anaemia occurred in 1 patient, and no treatment-related deaths were reported.
  • 12 of 50 patients (24%) who progressed after first-line therapy received second-line treatment. In these 12, median progression-free survival was 3.7 months and median overall survival 7.2 months. Disease control rate was 83%, one-year overall survival 37%, and one-year progression-free survival 16.7%.
  • Second-line comparison: the article states overall survival was 4.5 months longer with pemetrexed-based than other chemotherapy, printed as 6.0 versus 10.5 months (p = 0.47). Pemetrexed/platinum doublet versus single agents: median PFS 7.3 versus 3.0 months (p = 0.53), median OS 12.1 versus 4.5 months (p = 0.17). The authors stated these were not statistically significant.
  • The article reports significantly longer median overall survival in patients who received second-line therapy than in those who did not, printed as 12.5 versus 21.9 months (p = 0.031).
  • Second-line side effects: 2 patients stopped treatment because of side effects (grade 3 anaemia, grade 2 polyneuropathy). No grade 4 toxicity and no treatment-related deaths were reported.
• The authors' conclusion: The authors concluded that patients who benefit from first-line therapy and achieve progression-free survival longer than 6 months should be offered second-line treatment. They added that retreatment with the same cytotoxic agent, especially pemetrexed/platinum, seems a viable option when no alternative is available.
• Limitations the authors state:
  • The study has limitations typical of retrospective research.
  • The number of patients is small, which limits the power of comparisons between treatment groups.

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: Pleural Mesothelioma, Pleural Cavity, Asbestos Exposure, Pemetrexed (Alimta), First-line Therapy, Mesothelioma, Second-Line Therapy, Progression-Free Survival.

Related studies

• Real-life treatment practice for malignant pleural mesothelioma in Belgium — M. Rosskamp, G. Macq, et al. (2018)
• Clinical prognostic factors in pleural mesothelioma: best supportive care and anti-tumor treatments in a real-life setting — T. Ringgaard Petersen, V. Panou, et al. (2021)
• Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience — G. Lainakis, F. Zagouri, et al. (2011)
• Systemic treatment of malignant pleural mesothelioma: new agents in clinical trials raise hope of relevant improvements — D.C. Christoph, W.E. Eberhardt (2014)
• Systemic treatment of malignant pleural mesothelioma — F. Grosso, G.V. Scagliotti (2012)
• Multimodal Treatment of Malignant Pleural Mesothelioma: Real-World Experience with 112 Patients — A. Holzknecht, O. Illini, et al. (2022)

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