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Immediate Versus Deferred Systemic Therapy in Patients With Mesothelioma.

Sabine Schmid¹, Luna Zhan², Miguel Garcia³

¹University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medical Oncology, Inselspital, Bern University Hospital, Switzerland.

Clinical Lung Cancer

|June 2, 2024

Summary

Observing patients with asymptomatic, inoperable malignant pleural mesothelioma (MPM) and low disease burden may be a safe option. This approach did not negatively impact overall survival (OS) or progression-free survival (PFS) in selected patients.

Keywords:

ASCO Guideline Expectant observation Mesothelioma Systemic treatment

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Area of Science:

Oncology
Thoracic Surgery
Clinical Trials

Background:

The 2018 ASCO guideline suggests expectant observation for asymptomatic, inoperable epithelioid malignant pleural mesothelioma (MPM) with low disease burden.
Clinical characteristics and outcomes of MPM patients managed with initial observation and deferred treatment require evaluation.

Purpose of the Study:

To evaluate clinical characteristics and outcomes in malignant pleural mesothelioma (MPM) patients managed with initial observation and deferred treatment initiation.
To assess the impact of deferred systemic therapy on overall survival (OS) and progression-free survival (PFS) in selected MPM patients.

Main Methods:

Retrospective collection of clinicodemographic and outcome data from patients with inoperable malignant pleural mesothelioma (MPM).
Patients were categorized into two groups: immediate systemic treatment initiation versus observation with deferred treatment.
Comparison of patient characteristics, treatment patterns, and survival outcomes between the immediate and deferred treatment groups.

Main Results:

Of 222 advanced MPM patients, 15% (33 patients) were managed with deferred treatment.
The deferred treatment group was older, less likely to have stage IV disease, and more often had epithelioid histology.
Median overall survival (OS) was significantly longer in the deferred group (20.6 months) compared to the immediate treatment group (11.5 months); no significant difference in progression-free survival (PFS) was observed.

Conclusions:

Deferral of systemic therapy and close observation may be a viable strategy for selected malignant pleural mesothelioma (MPM) patients.
This approach did not negatively impact overall survival (OS) or physician-assessed progression-free survival (PFS) in this real-world analysis.