Trimodality therapy including surgery, chemotherapy, and radiation appears to give carefully-selected patients the best odds of surviving mesothelioma.
In a new article in the Journal of Clinical Oncology, researchers from MD Anderson Cancer Center detail the results of their analysis of mesothelioma survival using the National Cancer Database.
Long-Term Mesothelioma Research
The research team started with a pool of 20,561 pleural mesothelioma cases diagnosed between 2004 and 2014.
They then focused on 6,645 patients who were matched for their similar characteristics. Of these, 850 underwent mesothelioma surgery, 988 had surgery with chemotherapy, and 274 underwent trimodality therapy.
When the researchers compared the outcomes of mesothelioma patients with similar characteristics to each other, they found that cancer-directed surgery (surgery performed specifically to remove all or part of a tumor), chemotherapy, and radiation therapy were independently associated with improved survival.
“Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based and multimodality therapies,” writes lead author and thoracic surgeon David B. Nelson, MD.
A Powerful Combination
Malignant mesothelioma is a rare and aggressive malignancy that rarely responds to a single cancer therapy. The study data showed that the most positive treatment outcomes were seen in patients who had a very specific combination of therapies: cancer-directed surgery, chemotherapy, and radiation.
But pleural mesothelioma surgery is not without risk. Just over six percent of the subjects included in this study died within a month of their procedure and 15.5 percent did not survive beyond three months.
Best Results in Epithelioid Patients
The best news to come from the new study centers on people with the most common subtype of pleural mesothelioma called epithelioid. For these patients, trimodality therapy including surgery extended their survival by nearly nine months from 14.5 to 23.4 months.
The researchers conclude that surgery-based multimodality therapy has the power to improve the odds of surviving mesothelioma, especially when patients are carefully selected.
About 2,500 people are diagnosed with mesothelioma each year in the US. For most of them, the disease was the result of on-the-job exposure to the toxin, asbestos.
Nelson, DB, et al, “Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma: Propensity Score Matching Analysis”, August 17, 2017, Journal of Clinical Oncology, Epub ahead of print