Treatment patterns and outcomes in older patients with advanced malignant pleural mesothelioma: Analyses of Surveillance, Epidemiology, and End Results-Medicare data

Our plain-English summary of Treatment patterns and outcomes in older patients with advanced malignant pleural mesothelioma: Analyses of Surveillance, Epidemiology, and End Results-Medicare data, by M.D. Danese, M. Daumont, E. Nwokeji, et al (Cancer Reports, 2022).

The study

• Authors: M.D. Danese, M. Daumont, E. Nwokeji, M. Gleeson, J.R. Penrod, D. Lubeck
• Journal: Cancer Reports
• Published: 2022;5(9):e1568
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma is a rare neoplasm associated with asbestos exposure. Characterizing treatment patterns and outcomes of older patients with advanced malignant pleural mesothelioma (MPM) is important to understand the unmet needs of this population.

Aim: To evaluate the demographic and clinical characteristics, treatment patterns, and outcomes among older patients diagnosed with advanced MPM in the United States between 2007 and 2013.

Methods: This was a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims. We included patients who were age 66 or older at the time of their primary MPM diagnosis between 2007 and 2013 and followed them through 2014. Treated patients who received first-line chemotherapy with pemetrexed and platinum within 90 days of diagnosis, second-line, or third-line therapy were identified for evaluation of outcomes.

Results: There were 666 older patients with advanced MPM, of whom 82% were male, 87% White, 78% stage IV, and 70% had no mobility limitation indicators at diagnosis. There were 262 patients who received first-line chemotherapy for advanced MPM, most of whom (80%; n = 209) received pemetrexed-platinum. Of these 209 patients, 41% (n = 86) initiated second-line therapy, and 26% (n = 22) initiated third-line therapy. Median overall survival for the cohort of 209 patients was 7.2 months. Patients with epithelioid histology had better median overall survival (12.2 months) compared with other histologies (4.4-5.6 months). Within 90 days of diagnosis of advanced MPM, 78% of patients were hospitalized, 52% visited an emergency department, and 21% had hospice care. The 2-year cost of care was over $100 000 for all patients with advanced MPM treated with first-line pemetrexed-platinum.

Conclusions: Although first-line systemic anticancer treatment was generally consistent with guidelines (e.g., pemetrexed-platinum), poor patient outcomes highlight the need for effective treatment options for older patients with advanced MPM.

© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.

In plain English

This retrospective cohort study linked US cancer registry (SEER) data to Medicare claims. It covered 666 patients aged 66 or older with advanced malignant pleural mesothelioma diagnosed 2007 to 2013, followed through 2014; asbestos exposure was not examined. Of the 666, 262 received outpatient chemotherapy within 90 days of diagnosis; 209 of these started with pemetrexed plus a platinum drug. Of those 209, 86 received a second line of therapy, and 22 of those a third. About 90% of all 666 died during follow-up. Median survival from diagnosis for all 666 was 7.2 months (95% CI 6.6 to 8.2): 12.2 months (11.0 to 13.5) for epithelioid tumors, 4.4 months (3.8 to 6.0) for non-epithelioid tumors, and 5.6 months (4.7 to 6.8) when type was unspecified. For the 209, median survival from the start of first-line treatment was 10.7 months (95% CI 9.6 to 12.0). Within 90 days, 78% of all patients were hospitalized. Medicare-reimbursed costs over 24 months exceeded $100,000, in 2018 dollars, in each treated group. The authors concluded that poor outcomes highlight a need for more effective treatments.

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 observational cohort study using SEER cancer registry data linked with Medicare enrollment and claims data
• Who was studied: 666 Medicare patients aged 66 or older in SEER areas of the United States. All had microscopically confirmed advanced (T3, T4, N3 or M1) primary malignant pleural mesothelioma diagnosed between January 1, 2007 and December 31, 2013, and were followed to December 31, 2014. They were drawn from 3332 patients with MPM.
• Exposure: Asbestos exposure was not studied. The study examined systemic anticancer treatment, chiefly first-line pemetrexed plus a platinum drug (cisplatin or carboplatin), followed by second-line and third-line therapies.
• Main results:
  • Of the 666 patients with advanced MPM, 262 (39.3%) received outpatient systemic therapy within 90 days of diagnosis. Of these 262, 209 (80%) received pemetrexed-platinum as first-line therapy.
  • Of the 209 first-line pemetrexed-platinum patients, 86 (41%) received second-line therapy. Of those 86, 22 (26%) received third-line therapy.
  • In the first-line pemetrexed-platinum cohort, 47% received carboplatin and the rest received cisplatin.
  • Approximately 90% of the patients with advanced MPM died during follow-up.
  • Median overall survival from diagnosis for the whole advanced MPM cohort (666) was 7.2 months (95% CI 6.6 to 8.2).
  • In the advanced MPM cohort, median overall survival differed by tumor type. It was 12.2 months (95% CI 11.0 to 13.5) for epithelioid histology, 4.4 months (95% CI 3.8 to 6.0) for non-epithelioid histology, and 5.6 months (95% CI 4.7 to 6.8) for histology not otherwise specified.
  • In the first-line pemetrexed-platinum cohort (209), median overall survival from the start of first-line therapy was 10.7 months (95% CI 9.6 to 12.0).
  • Median overall survival was 5.3 months (95% CI 4.0 to 7.0) from the start of second-line therapy in the second-line cohort. It was 4.9 months (95% CI 3.8 to 7.3) from the start of third-line therapy in the third-line cohort.
  • In the advanced MPM cohort, worse survival was significantly associated with older age (HR 1.03 per year, 95% CI 1.02 to 1.04) and with any mobility limitation versus none (HR 1.33, 95% CI 1.10 to 1.61).
  • In the advanced MPM cohort, female sex was associated with a lower risk of death than male sex (HR 0.79, 95% CI 0.63 to 0.98).
  • Within 90 days of diagnosis in the advanced MPM cohort, 52% visited an emergency department, 78% were hospitalized, and 21% received hospice care.
  • In all three systemic therapy cohorts, Medicare-reimbursed costs over 24 months exceeded $100,000 in 2018 dollars.
• The authors' conclusion: The authors concluded that older patients with advanced MPM had low treatment rates and poor survival across lines of therapy. Although most received guideline-consistent treatment such as pemetrexed-platinum, the authors said their poor outcomes highlight where more effective treatment options could benefit this group.
• Limitations the authors state:
  • Systemic therapy given in hospital could not be identified, so those patients were not counted in the treated cohorts.
  • Results may be less relevant for younger patients and may not reflect recent treatment trends, because the data end in 2014.
  • The data do not capture non-covered services or the reasons behind patients' treatment choices.
  • Performance status is not available in SEER, so the authors used claims-based indicators of mobility limitation as a proxy.
  • Patients without staging information were excluded.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epidemiology, Malignant Mesothelioma, Neoplasm, Asbestos Exposure, Cohort Study, SEER, Chemotherapy.

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• Treatment Patterns and Outcomes of Patients With Advanced Pleural Mesothelioma at an Academic Referral Centre — S. Schmid, L. Zhan, et al. (2022)
• 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)
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• Malignant mesothelioma among US Medicare beneficiaries: incidence, prevalence and therapy, 2016-2019 — L. Kurth, J.M. Mazurek, et al. (2023)

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