Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma

Abstract

Background: Malignant pleural mesothelioma is a problematic condition due to poor prognosis and difficulties in management. We evaluated the treatment and outcome of 378 mesothelioma patients referred to 6 Italian Oncology Departments. Methods: Demographic and clinical data were collected. Treatment was assessed in terms of chemotherapy (line of treatment, pemetrexed-based regimen, other therapies), surgery, and radiotherapy. Response to therapy, progression-free survival, and overall survival were evaluated. Results: 36 and 342 patients received best supportive care and active treatment, respectively; 86 patients underwent surgery, and 26 received trimodal therapy. Disease control after first-line chemotherapy was achieved in 74.2% of patients (75.7% in patients treated with pemetrexed combined with other drugs and 69% with pemetrexed as monotherapy). The disease control rate was 82.6% in pemetrexed re-challenged individuals. Median survival time was 11.6 months with supportive care, 16.2 months with chemotherapy only, 32.4 months with surgery plus chemotherapy, and 47.2 months with trimodal therapy. A more favorable prognosis was observed in responders to first-line therapy who were then actively treated with second-line (24.8 vs. 11.8 months in non-responders, p < 0.001) and third-line chemotherapy (28.9 vs. 17.8 months in non-responders, p = 0.005). Conclusion: Mesothelioma patients benefited from chemotherapy alone only when retreated in the second line after response to first-line therapy.

Clinical prognostic factors in pleural mesothelioma: best supportive care and anti-tumor treatments in a real-life setting

“…While no significance was found in the treated group, only 14.7% were women, hence they were potentially underrepresented. Some previous studies have suggested that female gender is associated with improved OS in MM patients, while others did not [11,12,23]. This study indicates that female gender is a significant protective factor in BSC patients, although the mechanisms responsible for this are unclear [24].…”

“…Age was not a significant prognostic factor in either group. Other studies found that age was a significant factor [11,23]. However, they did not adjust for PS, and PS does not necessarily to correlate to age, as seen in other patient populations with cancer [27].…”

Surgical Management of Malignant Pleural Mesothelioma: From the Past to the Future

“…There are other treatments as PD with intraoperative intracavitary hyperthermic CT, although more studies need to support and analyze concerning the long-term results [105][106][107][108][109][110][111][112][113]. The majority of studies that evaluate the trimodal approach are retrospective reviews [114][115][116][117][118][119]. Since 2007, a multicentric clinical trial demonstrated that iCT plus EPP is feasible [41] showing an OS of 23 months compared with patients not treated with surgery with a survival of 19.8 months [41].…”

Combined use of irinotecan and p53 activator enhances growth inhibition of mesothelioma cells

“…However, the results of these have been disappointing [4][5][6]. Pemetrexed in combination with cisplatin is currently used as the standard first-line therapy for unresectable mesothelioma, yielding an overall survival time of 12.1 months [7].…”

“…Most MM patients have unresectable disease, and therefore, different anticancer drug regimens have been tested in clinical trials. However, the results of these have been disappointing [4–6]. Pemetrexed in combination with cisplatin is currently used as the standard first‐line therapy for unresectable mesothelioma, yielding an overall survival time of 12.1 months [7].…”