First-Line Chemotherapy versus Immunotherapy versus Maintenance Therapy

A recent study compared mesothelioma patients’ survival by physician’s choice of treatment. Is first-line chemotherapy the best choice?

Malignant pleural mesothelioma is an aggressive cancer that affects older adults. Mesothelioma patients often have other comorbidities making real-world treatment decisions challenging.

The first was by choice of first-line chemotherapy. The second was the physician’s choice of second-line chemotherapy versus immunotherapy. And the third was by the physician’s choice of use of maintenance therapy.

Physician’s Choice of First-Line Chemotherapy Drugs

This is the largest real-world study of U.S. patients diagnosed with mesothelioma. Scientists analyzed physicians’ choice of first-line chemotherapy, second-line therapy, and maintenance therapy.

In the first-line chemotherapy analysis, there was no significant difference in patient survival. As of this writing, the only FDA-approved chemotherapy is a combination of drugs.

This combination often includes Alimta (pemetrexed) and cisplatin. In this study, there was no evidence that cisplatin is superior to carboplatin.

Researchers said carboplatin is a suitable alternative to cisplatin-based chemotherapy. It gave a similar survival rate. And it has an improved safety and tolerability profile.

Physician’s Choice of Second-Line Immunotherapy vs. Chemotherapy

Oncologists found no significant difference between patients treated with immunotherapy versus single-agent chemotherapy. This is like other published data.

Studies have yet to show a survival benefit for second-line immunotherapy over first-line chemotherapy.

There was little difference between patients who did or did not have maintenance therapy. These findings support data showing a lack of survival benefit with maintenance pemetrexed.

Physician’s Choice and Shared-Decision Making

Mesothelioma is an aggressive cancer affecting older patients. It often creates therapeutic challenges for the practicing oncologist. This analysis found no significant differences in survival across the three choices.

The first was by choice of first-line chemotherapy. The second was the physician’s choice of second-line chemotherapy versus immunotherapy. And the third was by the physician’s choice of use of maintenance therapy.

This study included patients diagnosed with advanced mesothelioma between 2011-2019. The analysis from 2,065 patients did not show improved survival from chemotherapy. Suggestive evidence of a survival difference by choice of second-line immunotherapy versus chemotherapy. And no evidence of a survival difference by receipt of maintenance therapy.

Therapy selection for advanced mesothelioma patients should depend on shared decision-making.

Source

Kerrigan K, Jo Y, Chipman J, Haaland B, Puri S, Akerley W, Patel S, A Real-World Analysis of the use of Systemic Therapy in Malignant Pleural Mesothelioma and the Differential Impacts on Overall Survival by Practice Pattern, JTO Clinical and Research Reports (2022), doi: https://doi.org/10.1016/j.jtocrr.2022.100280.