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Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice
Published on: December 21, 2019
Systemic treatment in patients with malignant pleural mesothelioma - real life experience
Barbara Ziółkowska1, Bożena Cybulska-Stopa2, Dimitrios Papantoniou3,4
1Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland. barbara.ziolkowska@io.gliwice.pl.
Background:
Malignant pleural mesothelioma (MPM) is a rare, aggressive malignancy of the pleural cavity linked to asbestos exposure. The combination of pemetrexed and platinum is a standard first-line therapy for malignant pleural mesothelioma. Despite some progress, almost all MPM patients experience progression after first-line therapy. The second-line treatment is still being under discussion and there are very limited data available on the second-line and subsequent treatments.
Methods:
The retrospective analysis included 57 patients (16 females and 41 males) from two Polish oncological institutions treated for advanced mesothelioma between 2013 and 2019. We analysed the efficacy of first-line and second-line therapy: progression-free survival (PFS), overall survival (OS), overall response rate (ORR).
Results:
In the first-line treatment, 55 patients received pemetrexed-based chemotherapy (PBC) and two cisplatin in monotherapy. Patients' characteristics at baseline: median age was 64.2 years, ECOG PS ≤ 1 (86.2%), epithelial histology (85.7%). Median PFS and OS were 7.6 months and 14 months, respectively. Patients with ECOG PS ≤ 1 vs > 1 had a longer median OS (14.8 months vs 9.7 months, p = 0.057). One-year OS and PFS were 60.9% and 32.0%, respectively. Disease control rate (DCR) was 82.5%. Response to first-line therapy: PFS ≥ 6 months and PFS ≥ 12 months had a significant impact on median OS. Twelve patients received second-line therapy (seven PBC and five other cytotoxic single agents: navelbine, gemcitabine, or adriamycin/vincristine/methotrexate triplet). Median PFS and OS were 3.7 months and 7.2 months, respectively. DCR was 83%. One-year OS and PFS were 37% and 16.7%, respectively. In the group receiving PBC, OS was prolonged by 4.5 months compared to the non-PBC group (6.0 months vs 10.5 months, p = 0.47).
Conclusion:
Patients who benefited from first-line therapy and had prolonged PFS at first-line and achieve PFS longer than 6 months at first-line should be offered second-line treatment. Consideration of retreatment with the same cytotoxic agent could to be a viable option when no other treatment are available.
Insights
Second-line therapy for malignant pleural mesothelioma (MPM) may benefit patients who respond well to initial treatment. Retreatment with pemetrexed-based chemotherapy (PBC) shows promise when other options are limited.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Research
Background:
- Malignant pleural mesothelioma (MPM) is a rare, aggressive cancer linked to asbestos exposure.
- Pemetrexed and platinum chemotherapy is standard first-line treatment for MPM.
- Limited data exists on effective second-line and subsequent treatments for MPM.
Purpose of the Study:
- To analyze the efficacy of first-line and second-line therapies in advanced MPM patients.
- To evaluate progression-free survival (PFS), overall survival (OS), and overall response rate (ORR).
Main Methods:
- Retrospective analysis of 57 advanced MPM patients treated between 2013-2019.
- Assessment of first-line pemetrexed-based chemotherapy (PBC) and second-line treatments.
- Analysis of PFS, OS, and ORR.
Main Results:
- First-line PBC showed a median PFS of 7.6 months and OS of 14 months.
- Second-line therapy yielded a median PFS of 3.7 months and OS of 7.2 months.
- Patients with prolonged first-line PFS (≥6 months) and good performance status (ECOG PS ≤1) had better OS.
Conclusions:
- Second-line treatment should be considered for MPM patients who benefit from first-line therapy, especially those with PFS ≥ 6 months.
- Retreatment with PBC may be a viable option when other treatments are unavailable.
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