A Review of Pharmacologic Management in the Treatment of Mesothelioma

Borrelli, E.; McGladrigan, Conor G.

doi:10.1007/s11864-020-00807-y

Cited by 9 publications

(7 citation statements)

References 99 publications

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“…Uguen et al retrospectively reviewed and analyzed 146 patients with asbestos-related lung cancer, and the mean duration of the latency period was 10.5 ± 8.6 years [ 59 ]. According to a literature review published recently by Borrelli et al, the latency period of mesothelioma induced by occupational asbestos exposure was approximately 20–70 years [ 60 ]. Rarely could evidence discussing the duration of asbestos-related esophageal cancer be found.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Association between Asbestos Exposure and Esophageal Cancer

Chuang

Tsai

et al. 2021

IJERPH

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Background: We conducted a meta-analysis to quantitatively assess the association between asbestos exposure and esophageal cancer. Methods: We systematically collected articles from three electronic databases and calculated the pooled standardized mortality rate (SMR) from the meta-analysis. Subgroup analysis according to the type of asbestos exposure, follow-up years, sample size, industry classification, sex, and high-dose exposure was conducted. Results: From 242 studies, 34 cohort studies were included in our meta-analysis. Pooled SMR was positively associated with asbestos exposure and esophageal cancer (pooled SMR = 1.28; 95% confidence interval (CI) 1.19–1.38, p < 0.00001). In the subgroup analysis, (1) chrysolite, (2) four groups with follow-up over ten years, (3) the textile industry and shipyard, (4) both male and female, and (5) eight studies on highest asbestos exposure, all the subgroups showed significantly increased pooled SMRs. Conclusion: Asbestos exposure was significantly and positively associated with esophageal cancer, especially chrysolite. Considering the long latency period, we suggest that patients should be followed up for cancer, including esophageal cancer, for over ten years.

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Association between Asbestos Exposure and Esophageal Cancer

Chuang

Tsai

et al. 2021

IJERPH

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“…The estimated drug cost for cisplatin plus pemetrexed is $46 225 for 6 cycles, whereas the US patent on bevacizumab expired in 2019 and its European patent expires in 2022. Conversely, the combined cost for nivolumab plus ipilimumab is approximately $153 800 for 4 cycles, further stressing the need to consider the best treatment options with greater care. Such high-cost cancer drugs are currently being appraised by national health technology assessment agencies such as the Institute for Clinical and Economic Review and National Institute for Health and Care Excellence to determine whether they represent a cost-effective use of public resources measuring the cost per quality-adjusted life-year.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3 Randomized Clinical Trials of Frontline Therapies for Malignant Pleural Mesothelioma

et al. 2022

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IMPORTANCE Some recently proposed frontline therapies for malignant pleural mesothelioma (MPM) are very costly, yet their impact on quality of life and overall survival of these patients remains arguable. Given the high social toll of this aggressive occupational cancer, it is paramount to establish the real clinical benefit of these treatments. OBJECTIVETo directly compare and analyze the statistical robustness of the 3 randomized clinical trials (RCTs) of frontline therapies recommended for MPM since 2003. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study assessed the following phase 3 RCTs: the Mesothelioma Cisplatin Pemetrexed Study (MPS) of cisplatin plus pemetrexed vs cisplatin; the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS) of cisplatin plus pemetrexed plus bevacizumab vs cisplatin plus pemetrexed; and the CheckMate743 (CM743) study of nivolumab plus ipilimumab vs cisplatin plus pemetrexed. Data collection dates for the RCTs ranged from April 1999 to April 2018. Data for this study were analyzed from February to October 2021. MAIN OUTCOMES AND MEASURES Patient selection criteria, superiority of the intervention groups, survival-inferred fragility index, and censoring patterns in each RCT. RESULTS A total of 1501 patients were included in the analysis (1170 men [77.9%]; range of median age for treatment groups, 60 [IQR, 19-84] to 69 [IQR, 65-75] years). A virtual comparison of overall survival in MAPS vs the CM743 study showed no statistically significant difference (hazard ratio [HR], 0.97 [95% CI, 0.79-1.20]; P = .79), and the survival-inferred fragility index in the intention-to-treat (ITT) populations was as low as 0.22% of the total sample size in MPS, −0.45% of the total sample size in MAPS, and 0.99% of the total sample size in the CM743 trial. Moreover, reverse restricted mean survival time (RMST) analysis of overall survival using RMST-difference (RMST-D) demonstrated differential censoring in the ITT population of the CM743 trial favoring the control group (0.56 [95% CI, 0.18-0.94]; P = .004) and in the nonepithelioid group (reverse RMST-D, 0.90 [95% CI, 0.001-1.79]; P = .048). CONCLUSIONS AND RELEVANCEThis comparative effectiveness study found no survival benefit in the CM743 trial over MAPS, despite the inclusion of patients with worse prognosis in the latter trial.Moreover, the statistical conclusions of all the examined trials were shown to be extremely fragile, and the findings of differential censoring in the CM743 trial and in the ITT nonepithelial subset raised additional areas of concern. These findings suggest that selection criteria, fragility, and censoring patterns may affect the original conclusions drawn for the respective trials, casting a shadow on the (continued)

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“…However, as novel treatments with increased efficacy will emerge in the clinical practice, the medication costs are expected to increase substantially in the near future. 28 In addition to treatment, surgical interventions play an important role in the diagnosis, staging, and palliative management of MPM. 12,20 At least during the study period in Finland, multimodality treatment approaches were not used, and therefore, patients undergoing surgery would receive another treatment only after possible recurrence of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Evidence for marked underutilization of insurance billing in malignant pleural mesothelioma in Finland

et al. 2021

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Background: Substantial variation in health care costs for malignant pleural mesothelioma (MPM) has previously been identified. Materials and Methods: We analyzed the changes in health care costs in MPM in Finland during 2002-2012. Finland has low-threshold public health care and a mandatory Workers' Compensation scheme that covers all occupational-related disease expenses. The costs include treatment costs for inpatients, hospice care, medication costs, rehabilitation costs, and travel costs. All costs are expressed in 2012 prices, adjusted using the consumer price index. Results: A total of 907 MPM patients were included in the study. Mean duration of inpatient episodes increased 7% per year from 2002 to 2012, correlating with total costs (R 2 = 0.861, p < 0.05). The annual total costs for treatment increased from 1.7 to 4.3 m€ during the study period and the cost per patient from 27 000 to 43 000 €. The overall costs increased progressively by the number of procedures performed. In patients who had been compensated for occupational cause by Workers' Compensation Center, only 36% of the overall care costs were billed from the insurance company. Billing of inpatient costs was 86% in these patients. Conclusion:During the study period, we found that the costs of MPM increased more than the average health care costs. This may be because of advanced diagnostic workup or more costly treatment (e.g., pemetrexed). Moreover, only one-third of all health care costs are charged to Workers' Compensation Insurance.

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A Review of Pharmacologic Management in the Treatment of Mesothelioma

Cited by 9 publications

References 99 publications

Meta-Analysis of the Association between Asbestos Exposure and Esophageal Cancer

Meta-Analysis of the Association between Asbestos Exposure and Esophageal Cancer

Comparison of 3 Randomized Clinical Trials of Frontline Therapies for Malignant Pleural Mesothelioma

Evidence for marked underutilization of insurance billing in malignant pleural mesothelioma in Finland

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