Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial)

Abstract

PurposeWe conducted a prospective multi-institutional study to determine the feasibility of trimodality therapy (TMT) comprising induction chemotherapy followed by extrapleural pneumonectomy (EPP) and radiation therapy in Japanese patients with malignant pleural mesothelioma (MPM). MethodsMajor eligibility criteria were histologically confirmed diagnosis of MPM, including clinical subtypes T0–3, N0–2, M0 disease; no prior treatment for the disease; age 20–75 years; Eastern Cooperative Oncology Group performance status 0 or 1; predicted postoperative forced expiratory volume >1000 ml in 1 s; written informed consent. Treatment methods comprised induction chemotherapy using pemetrexed (500 mg/m2) plus cisplatin (60 mg/m2) for three cycles, followed by EPP and postoperative hemithoracic radiation therapy (54 Gy). Primary endpoints were macroscopic complete resection (MCR) rate for EPP and treatment-related mortality for TMT.ResultsForty-two eligible patients were enrolled: median age 64.5 (range 43–74) years; M:F = 39:3, clinical stage I:II:III = 14:13:15; histological type epithelioid were sarcomatoid; biphasic; others = 28:1:9:4. Of 42 patients, 30 completed EPP with MCR and 17 completed TMT. The trial met the primary endpoints, with an MCR rate of 71 % (30/42) and treatment-related mortality of 9.5 % (4/42). Overall median survival time and 2-year survival rate for 42 registered patients were 19.9 months and 42.9 %, respectively. Two-year relapse-free survival rate of 30 patients who completed EPP with MCR was 37.0 %.ConclusionThis phase II study met the predefined primary endpoints, but its risk/benefit ratio was not satisfactory.Electronic supplementary materialThe online version of this article (doi:10.1007/s10147-015-0925-1) contains supplementary material, which is available to authorized users.

The role of radical radiotherapy in the management of malignant pleural mesothelioma: A systematic review

“…[15] Table 5 summarises data from five multicentre studies (including three phase II trials), which assessed efficacy and feasibility of the trimodality approach. [46–50] A variety of radiotherapy techniques were used and median overall survival rates of between 15.5 and 19.9 months are reported, with several studies noting an increase in median survival for patients completing EPP [46, 48, 49] and a further survival benefit in patients completing radiotherapy. [47–49]…”

Is Pleurectomy/Decortication Superior to Extrapleural Pneumonectomy for Patients with Malignant Pleural Mesothelioma? A Single-Institutional Experience

“…3) However, EPP is one of the most invasive procedures in thoracic surgery, and high morbidity and mortality rates have been reported. 4) In the MARS 1 trial, 5) all patients underwent induction platinum-based chemotherapy and were randomly assigned to either EPP followed by hemithorax irradiation or no EPP. Surprisingly, radical surgery in the form of EPP within trimodal therapy offered no benefit and was associated with a risk of harming patients.…”

Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma

“…Radiofrequency ablation was therefore performed; the course was uneventful, and there was no recurrence. Radiofrequency ablation should be considered an option to treat recurrence of malignant pleural mesothelioma.(Ann Thorac Surg 2018;105:e265-7) Ó 2018 by The Society of Thoracic Surgeons M alignant pleural mesothelioma (MPM) is an aggressive tumor with poor prognosis and few effective treatment options [1]. Several recent studies have addressed the efficacy of multimodality treatment for MPM; however, most patients have recurrence after such treatment.…”