Real-world prognostic model for malignant pleural mesothelioma.

e20562 Background: Two mesothelioma prognostic models have been suggested: European Organisation for Research and Treatment of Cancer (EORTC) and Cancer and Leukaemia Group B (CALGB) models. Both were based on clinical trial patients enrolled in the mid-1980s to early-1990s. Several changes to mesothelioma management have been adopted since publication of these models, including improved surgical and palliative interventions and changes to systemic therapy. Methods: With ethics approval, we collected and analyzed the health data of malignant pleural mesothelioma (MPM) patients with histologically confirmed diagnosis treated at our institution between January 1991 and March 2019. The primary endpoint was overall survival (OS). Univariate analysis was used to identify significant predictors of survival, which were then used to construct a multivariate survival tree with complete case-analysis and bootstrapping. Patients were then stratified into three prognostic groups based on their median OS. Results: 337 patients were included in the study; 309 (91.7%) were dead at last follow-up. The median OS was 9.4 (8.1-11.5) months for the entire population. Eastern Cooperative Oncology Group (ECOG) performance status (PS), histology, white blood count, platelets, International Mesothelioma Interest Group stage, age and hemoglobin were independent predictors of survival. The final pruned survival tree was based on 285 patients and incorporated the first five predictors. Good, intermediate and poor prognostic groups had median OS of > 12 months, 6-12 months, and < 6 months, respectively. Factors associated with the prognostic groups were: good prognosis: ECOG 0-1, normal platelets, stage 1, 2 and epithelioid histology; intermediate prognosis: ECOG 0-1 with either stage 3, 4 and/or sarcomatoid or biphasic histology; poor prognosis: ECOG 2-4 regardless of other factors. Conclusions: In contrast to EORTC/CALGB, real world evidence generates these prognostic groups with face validity but will need independent validation. Our data does not account for recent advances including immunotherapy, and thus patients with non-epithelioid histology may have better survival than predicted.[Table: see text]

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P2.06-17 Real-World Accuracy of Malignant Pleural Mesothelioma (MPM) Preoperative Magnetic Resonance Imaging (MRI) for Staging the Diaphragm.

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2018.08.1272 ◽

2018 ◽

Vol 13 (10) ◽

pp. S748-S749

Author(s):

S. Katz ◽

S. Mcnulty ◽

K. Cengel ◽

E. Alley ◽

S. Singhal

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Malignant Pleural Mesothelioma ◽

Real World ◽

Preoperative Magnetic Resonance Imaging ◽

Pleural Mesothelioma ◽

Resonance Imaging ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri

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Frequency of use and outcome of surgical resection in the management of malignant mesothelioma in a community-based population: Results in 5,937 patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.7510 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 7510-7510

Author(s):

R. M. Flores ◽

E. Riedel ◽

J. S. Donington ◽

L. Krug ◽

K. Rosenzweig ◽

...

Keyword(s):

Surgical Resection ◽

Median Survival ◽

Malignant Pleural Mesothelioma ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Univariate Analysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Pleural Mesothelioma ◽

Tertiary Referral

7510 Background: Multimodality therapy of mesothelioma patients treated at specialized tertiary hospitals report surgical resection rates of 42% (Flores RM et al. Prognostic Factors in the Treatment of Malignant Pleural Mesothelioma at a Large Tertiary Referral Center. J Thorac Oncol 2007;2(10):957–965.). Treatment strategies in the community are less well defined and surgical expertise is not readily available. We undertook this study to evaluate the rate of surgical resection and its association with survival in a non-tertiary based population. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was searched from 1990 - 2004. Variables analyzed included age, sex, race, year of diagnosis, laterality, vital status, stage, surgery, and reasons for no surgery. The association of resection on overall survival was estimated by the Kaplan-Meier method and examined in a Cox proportional hazards model adjusting for covariates. Results: Pathologically proven malignant pleural mesothelioma was identified in 5,937 patients: 1,166 women, 4,771 men; median age was 70 years. Surgical resection rate was 11% (n=636). Univariate analysis demonstrated a median survival of 13 months with surgical resection and a median survival of 7 months in the non-resected group (p<0.0001). Multivariate analysis demonstrated improved survival for surgically resected patients (HR 0.7, p<0.0001), controlling for age, gender, and stage. Conclusions: Surgical resection was associated with improved survival when controlling for age, stage, and gender. However, the rate of surgical resection was much lower in the community when compared to tertiary referral centers. Treatment efforts should be focused on a multidisciplinary approach which includes surgical evaluation. No significant financial relationships to disclose.

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Nintedanib Plus Pemetrexed/Cisplatin in Patients With Malignant Pleural Mesothelioma: Phase II Results From the Randomized, Placebo-Controlled LUME-Meso Trial

Journal of Clinical Oncology ◽

10.1200/jco.2017.72.9012 ◽

2017 ◽

Vol 35 (31) ◽

pp. 3591-3600 ◽

Cited By ~ 59

Author(s):

Federica Grosso ◽

Nicola Steele ◽

Silvia Novello ◽

Anna K. Nowak ◽

Sanjay Popat ◽

...

Keyword(s):

Overall Survival ◽

Placebo Group ◽

Phase Ii ◽

Malignant Pleural Mesothelioma ◽

Group Performance ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Phase Iii ◽

Pleural Mesothelioma ◽

Double Blind

Purpose LUME-Meso is a phase II/III randomized, double-blind trial designed to assess efficacy and safety of nintedanib plus chemotherapy as first-line treatment of malignant pleural mesothelioma (MPM). Phase II results are reported here. Patients and Methods Chemotherapy-naïve patients with unresectable, nonsarcomatoid MPM (Eastern Cooperative Oncology Group performance status 0 to 1), stratified by histology (epithelioid or biphasic), were randomly assigned in a 1:1 ratio to up to six cycles of pemetrexed and cisplatin plus nintedanib (200 mg twice daily) or placebo followed by nintedanib plus placebo monotherapy until progression. The primary end point was progression-free survival (PFS). Results Eighty-seven patients were randomly assigned. The median number of pemetrexed and cisplatin cycles was six; the median treatment duration for nintedanib was 7.8 months and 5.3 months for placebo. Primary PFS favored nintedanib (hazard ratio [HR], 0.56; 95% CI, 0.34 to 0.91; P = .017), which was confirmed in updated PFS analyses (HR, 0.54; 95% CI, 0.33 to 0.87; P = .010). A trend toward improved overall survival also favored nintedanib (HR, 0.77; 95% CI, 0.46 to 1.29; P = .319). Benefit was evident in epithelioid histology, with a median overall survival gain of 5.4 months (HR, 0.70; 95% CI, 0.40 to 1.21; P = .197; median [nintedanib v placebo], 20.6 months v 15.2 months) and median PFS gain of 4.0 months (HR, 0.49; 95% CI, 0.30 to 0.82; P = .006; median [nintedanib v placebo], 9.7 v 5.7 months). Neutropenia was the most frequent grade ≥ 3 adverse event (AE; nintedanib 43.2% v placebo 12.2%); rates of febrile neutropenia were low (4.5% in nintedanib group v 0% in placebo group). AEs leading to discontinuation were reported in 6.8% of those receiving nintedanib versus 17.1% of those in the placebo group. Conclusion Addition of nintedanib to pemetrexed plus cisplatin resulted in PFS improvement. AEs were manageable. The clinical benefit was evident in patients with epithelioid histology. The confirmatory phase III part of the study is ongoing.

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549P Prognostic factors and clinical outcomes of malignant pleural mesothelioma in a real world-setting: An Asian cohort

Annals of Oncology ◽

10.1016/s0923-7534(21)00707-9 ◽

2016 ◽

Vol 27 ◽

pp. ix178

Author(s):

T.-H. Wu ◽

L.J.-H. Lee ◽

C.-T. Yuan ◽

T.W.-W. Chen

Keyword(s):

Prognostic Factors ◽

Clinical Outcomes ◽

Malignant Pleural Mesothelioma ◽

Real World ◽

Pleural Mesothelioma ◽

Real World Setting ◽

Asian Cohort

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Real-world use of systemic therapy in elderly patients with malignant pleural mesothelioma (MPM)

Annals of Oncology ◽

10.1093/annonc/mdz266.012 ◽

2019 ◽

Vol 30 ◽

pp. v752

Author(s):

S. Cedres ◽

J.D. Assaf ◽

P. Iranzo ◽

A. Callejo ◽

N. Pardo ◽

...

Keyword(s):

Elderly Patients ◽

Malignant Pleural Mesothelioma ◽

Real World ◽

Systemic Therapy ◽

Pleural Mesothelioma

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Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.3.527 ◽

1988 ◽

Vol 6 (3) ◽

pp. 527-535 ◽

Cited By ~ 181

Author(s):

A S Alberts ◽

G Falkson ◽

L Goedhals ◽

D A Vorobiof ◽

C A Van der Merwe

Keyword(s):

Malignant Pleural Mesothelioma ◽

Early Stage ◽

Performance Status ◽

Univariate Analysis ◽

Treatment Modalities ◽

Pleural Mesothelioma ◽

Phase Ii Trials ◽

Duration Of Symptoms ◽

Histologic Subtype ◽

Treatment Groups

From 1965 to 1985, 262 patients with malignant pleural mesothelioma were treated with cytostatics only; radiotherapy (RT); RT and cytostatics; or decortication plus RT plus cytostatics. The median survival (MS) from diagnosis was 9.6 months. This was similar for all comparable treatment groups. In a univariate analysis, significant favorable prognostic factors were good performance status (PS), duration of symptoms greater than 6 months at the time of diagnosis, early stage of disease, white race, and female sex. In a multivariate analysis, PS, race, duration of symptoms, and stage were of significance for a favorable prognosis. Age, pain as first symptom, histologic subtype, and RT dose were not of prognosis significance in this study. The stepwise addition of treatment modalities did not increase survival, which remained the same as that reported for untreated patients. Therefore, phase II trials of new agents offer the only hope for advance in the treatment of this disease.

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