Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma

Weder, Walter; Stahel, Rolf A.; Bernhard, J.; Bodis, Stephan; Vogt, Peter R.; Ballabeni, Pierluigi; Lardinois, Didier; Betticher, Daniel; Schmid, Ralph A.; Stupp, Roger; Ris, Hans; Jermann, Monika; Mingrone, Walter; Roth, Arnaud; Spiliopoulos, Anastase

doi:10.1093/annonc/mdm093

Cited by 288 publications

(171 citation statements)

References 32 publications

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“…In a Swiss multicentre trial, three cycles of cisplatin and gemcitabine were given as induction therapy followed by EPP and post-operative radiotherapy to incompletely resected areas [41]. In total, 61 patients with clinical T2N2M0 mesothelioma or less were included and 45 patients underwent EPP with or without post-operative radiotherapy.…”

Section: Combined-modality Therapymentioning

confidence: 99%

Multimodal management of malignant pleural mesothelioma: where are we today?

Schil

Opitz²,

Weder³

et al. 2014

European Respiratory Journal

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The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. Moreover, the extent of resection and precise surgical procedure remain a highly debated topic. To better compare and combine results from different institutions and trials, uniform definitions of surgical procedures including extrapleural pneumonectomy and different forms of pleurectomy have recently been introduced. Due to the relatively higher morbidity and mortality of extrapleural pneumonectomy, there is currently a shift towards pleurectomy/decortication when a macroscopic complete resection of all tumour can be obtained by this procedure. In most recent trials, induction chemotherapy was administered to improve surgical resection rates but pathological complete responses are infrequently observed. The role of post-operative radiotherapy has to be further elucidated.Further treatment options that are currently explored include hyperthermic intrapleural chemotherapy, immunotherapy, gene therapy and photodynamic therapy. However, no randomised comparisons are available yet. @ERSpublications Treatment of malignant pleural mesothelioma remains controversial

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Section: Combined-modality Therapymentioning

confidence: 99%

Multimodal management of malignant pleural mesothelioma: where are we today?

Schil

Opitz²,

Weder³

et al. 2014

European Respiratory Journal

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“…Previously rare, MM is increasing in incidence in developed countries (2), but because of the continued widespread use of asbestos in developing countries (3), MM will remain a worldwide health issue in the ensuing decades. Furthermore, MM remains an invariably fatal disease, with a median survival ranging from 7 to 24 months depending on the stage of the disease and modalities of treatments used (4)(5)(6).…”

mentioning

confidence: 99%

High Blood Neutrophil-to-Lymphocyte Ratio Is an Indicator of Poor Prognosis in Malignant Mesothelioma Patients Undergoing Systemic Therapy

Kao

Pavlakis

Harvie

et al. 2010

Clinical Cancer Research

280

239

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Purpose: Asbestos-induced chronic inflammation is implicated in the pathogenesis of malignant mesothelioma (MM). We have investigated blood neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation, as a prognostic factor in MM patients.Experimental Design: Patients with MM who had systemic therapy at participating institutes were studied. Potential prognostic factors such as age, gender, performance status, histologic subtype, and baseline laboratory parameters, including NLR, were analyzed. Overall survival from commencement of therapy was determined by the Kaplan-Meier method. Multivariate analyses using Cox Regression model were performed with significant factors (P 0.05) to determine their independent effect.Results: A total of 173 MM patients undergoing systemic therapy including 119 patients receiving firstline therapy and 54 patients receiving second-or third-line therapy were included in this retrospective evaluation. Forty-two percent of patients had an elevated NLR at baseline. The following variables were predictive of survival: female gender (P ¼ 0.044), epithelioid histologic subtype (P < 0.001), baseline white blood cell count less than 8.3 Â 10 9 /L (P ¼ 0.008), baseline platelet count 400 Â 10 9 /L or less (P ¼ 0.05), and NLR of 5 or less (P < 0.001). After multivariate analysis, histologic epithelioid subtype [hazard ratio (HR) ¼ 2.0; 95% confidence interval (CI) ¼ 1.3-2.9; P ¼ 0.001], and NLR less than 5 (HR ¼ 2.7; 95% CI ¼ 1.8-3.9; P < 0.001) remained independent predictors. The 1-year survival rate was 60% versus 26%, whereas the 2-year survival rate was 34% versus 10% for NLR less than 5 and 5 or greater, respectively. In the separate analyses of chemotherapy-naive and previously treated patient groups, NLR was an independent predictor of survival in both groups.Conclusion: Our results indicate that NLR is an independent predictor of survival for patients with MM undergoing systemic therapy. Clin Cancer Res; 16(23); 5805-13. Ó2010 AACR.

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“…Wyniki dotychczasowych badań II fazy, w których w wybranych grupach chorych kojarzono indukcyjną chemioterapię z miejscowymi metodami, są obiecujące [153][154][155][156]. Postępowanie takie można rozważyć u wybranych chorych w I-III stopniu zaawansowania i bez przerzutów w węzłach chłonnych śródpiersia.…”

Section: Chemioterapia W Złośliwym Międzybłoniaku Opłucnejunclassified

Rola systemowych metod leczenia u chorych na niedrobnokomórkowego raka płuca i złośliwego międzybłoniaka opłucnej: Uaktualnione zalecenia ekspertów

Jassem

Biernat

Bryl

et al. 2014

Advances in Respiratory Medicine

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Rak płuca jest w Polsce najczęstszą przyczyną zgonów nowotworowych. Około 85% wszystkich nowotworów płuca stanowi rak niedrobnokomórkowy (NDRP), w którym leki cytotoksyczne i ukierunkowane molekularnie odgrywają coraz większą rolę. W pracy przedstawiono oparte na obecnej wiedzy zalecenia dotyczące stosowania tych metod w praktyce klinicznej u chorych na NDRP oraz na złośliwego międzybłoniaka opłucnej.

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Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma

Abstract: The observed rate of operability is promising. A median survival of 23 months for patients undergoing EPP compares favourably with the survival reported from single center studies of upfront surgery. This approach was not associated with an increase in psychological distress.

Cited by 288 publications

References 32 publications

Multimodal management of malignant pleural mesothelioma: where are we today?

Multimodal management of malignant pleural mesothelioma: where are we today?

High Blood Neutrophil-to-Lymphocyte Ratio Is an Indicator of Poor Prognosis in Malignant Mesothelioma Patients Undergoing Systemic Therapy

Rola systemowych metod leczenia u chorych na niedrobnokomórkowego raka płuca i złośliwego międzybłoniaka opłucnej: Uaktualnione zalecenia ekspertów

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