Four-modality therapy in malignant pleural mesothelioma: a phase II study

Area of Science:

• Oncology
• Thoracic Surgery
• Immunotherapy

Background:

• Malignant pleural mesothelioma (MPM) lacks a consensus optimal treatment strategy.
• Treatment options range from palliative care to aggressive therapies.
• A phase II study was initiated in 1999 to evaluate a novel four-modality approach for advanced MPM.

Purpose of the Study:

• To investigate the feasibility, tolerability, and efficacy of a four-modality treatment for advanced-stage malignant pleural mesothelioma (MPM).
• To assess survival outcomes in MPM patients receiving a multi-modal therapeutic regimen.

Main Methods:

• A total of 49 patients with International Mesothelioma Interest Group stage II-III MPM were treated between 1999 and 2004.
• The four-modality treatment included intrapleural interleukin-2, pleurectomy/decortication, intrapleural epidoxorubicin, adjuvant radiotherapy, systemic chemotherapy (cisplatin and gemcitabine), and long-term subcutaneous interleukin-2.
• Patients were monitored for postoperative morbidity and survival outcomes.

Main Results:

• No postoperative mortality was observed; morbidity included bleeding and arrhythmias.
• The median follow-up was 59 months, with 13 patients surviving.
• The median actuarial survival was 26 months, with 2- and 5-year survival rates of 60.2% and 23.3%, respectively.
• Eastern Cooperative Oncology Group performance status was a significant predictor of survival (p = 0.02).

Conclusions:

• The investigated four-modality treatment for advanced-stage MPM is feasible and generally well-tolerated.
• This treatment approach resulted in a favorable median survival for MPM patients.
• The study suggests this multi-modal therapy warrants further investigation for malignant pleural mesothelioma.