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Published on: December 21, 2019
Pemetrexed in malignant pleural mesothelioma and the clinical outcome
Aija Knuuttila1, Eija-Riitta Salomaa, Suvi Saikkonen
1Department of Medicine, Division of Pulmonary Medicine, Helsinki University Central Hospital, Helsinki, Finland. aija.knuuttila@hus.fi
Introduction:
Pemetrexed has emerged as standard chemotherapy for malignant pleural mesothelioma (MPM).
Objectives:
MPMs at two Finnish University Hospitals during 7 years (2000-2006) were reviewed in order to evaluate the treatments, survival and prognostic factors. The results in two periods (before pemetrexed use in 2000-2002 and with pemetrexed in 2003-2006) were compared.
Methods:
Data were collected from the individual patient records retrospectively, and analysed.
Results:
Altogether 197 patients were diagnosed with following histologies: 136 (69%) epithelioid, 19 (10%) sarcomatoid, 17 (9%) mixed, 25 (13%) not specified; 141 (72%) patients received treatment (five extrapleural pneumonectomy, 36 pleurectomy/decortication, 126 chemotherapy). Median survival was 12.9 months and the 1-, 2- and 3-year survivals were 51.8%, 21.8% and 12.1%, respectively. Univariate analysis showed no significant difference in survival between the patients diagnosed before or during the pemetrexed era (P = 0.124). The patients receiving pemetrexed or other chemotherapy had median survivals of 16.7 and 15.3 months, respectively. The independent prognostic factors for survival were histology and asbestos exposure. Non-epithelioid histology yielded 17 times higher risk of dying than epithelioid. Asbestos exposure doubled the risk of dying, but only in patients diagnosed in 2003-2006.
Conclusions:
Pemetrexed is beneficial for selected patients, but it has not changed the outcome of the whole MPM population as much as perhaps anticipated. Patient groups with various treatments or symptomatic care only reached survival results comparable to those reported in chemotherapy trials, thus emphasising the need for better subtyping of mesothelioma and individualising the treatment.
Insights
Pemetrexed chemotherapy did not significantly alter overall survival for malignant pleural mesothelioma (MPM) patients. Histology and asbestos exposure remain key prognostic factors, highlighting the need for personalized treatment strategies.
Area of Science:
- Oncology
- Thoracic Surgery
- Epidemiology
Background:
- Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer.
- Pemetrexed has become a standard chemotherapy agent for MPM treatment.
Purpose of the Study:
- To evaluate treatment patterns, survival outcomes, and prognostic factors in MPM patients.
- To compare outcomes before and after the introduction of pemetrexed.
Main Methods:
- Retrospective analysis of 197 MPM patient records from two Finnish university hospitals (2000-2006).
- Comparison of survival data between pre-pemetrexed (2000-2002) and pemetrexed eras (2003-2006).
Main Results:
- Median survival was 12.9 months; 1-, 2-, and 3-year survivals were 51.8%, 21.8%, and 12.1%.
- No significant survival difference was observed between the pre-pemetrexed and pemetrexed eras (P=0.124).
- Independent prognostic factors included non-epithelioid histology (17x higher risk of death) and asbestos exposure (doubled risk in the pemetrexed era).
Conclusions:
- Pemetrexed offers benefits to select MPM patients but has not dramatically improved overall population outcomes.
- Survival in various treatment groups was comparable to chemotherapy trials, emphasizing the need for better mesothelioma subtyping and individualized treatment approaches.
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