The older a mesothelioma patient is, the less likely he or she may be to receive mesothelioma chemotherapy. A new study says many older mesothelioma sufferers may be paying the price in shorter lifespans.
Chemotherapy with pemetrexed (Alimta) and cisplatin is the gold standard for mesothelioma treatment. Many studies have linked it with longer mesothelioma survival.
But an Australian study suggests that not enough older people are receiving mesothelioma chemotherapy.
In fact, the older they are, the less likely they are to have chemotherapy for their mesothelioma. As a result, their chances of dying from malignant mesothelioma are higher.
Mesothelioma Chemotherapy is Standard of Care
Malignant mesothelioma is a hard-to-treat cancer with a poor prognosis. Mesothelioma chemotherapy is the primary way oncologists try to help extend survival.
Most patients undergo other treatments along with mesothelioma chemotherapy. These might include surgery, intrapleural chemotherapy, radiation, or immunotherapy.
But there is one group of mesothelioma patients who are not getting the benefits of mesothelioma chemotherapy as often as they could be. Others may be receiving chemotherapy when it could do more harm than good.
Analyzing Chemotherapy Use Among Mesothelioma Patients
Australia was once a major global producer of asbestos and now has one of the highest per capita rates of asbestos cancer in the world.
Researchers with Australia’s Asbestos DIseases Research Institute in Sydney conducted the new study. It included 910 mesothelioma patients. Forty-one percent of the patients were younger than 70. Forty percent were between 70 and 80. The final 19 percent were over 80.
The study found that the median overall mesothelioma survival rate in these patients decreased as they got older, as did chemotherapy use.
Mesothelioma Chemotherapy and Survival
Only 66 percent of patients under 70 received mesothelioma chemotherapy. That group had a median survival of 13.5 months. The rate of chemotherapy dropped to just 35 percent in mesothelioma patients between 70 and 80. Survival in this group was 9.5 months.
Among mesothelioma patients over 80, only 8 percent received chemotherapy. Their median overall survival was just 7.1 months.
“A Kaplan Meier analysis revealed that there was a significant survival advantage for patients under 70 and 70 to 80 years receiving chemotherapy, but not for patients over 80 years,” writes author Anthony Linton.
Patients under 70 who did receive chemotherapy had a survival rate of 16.8 months. Patients in the same age group who did not have mesothelioma chemotherapy had a median survival of just 7 months.
A similar difference was observed in the 70 to 80 year old group. With mesothelioma chemotherapy, those patients lived for a median of 13.9 months. Without it, survival dropped to just 5.8 months. Patients over 80 did not live longer with chemotherapy.
The authors do not explore why there is a difference in chemotherapy use in older patients. They conclude that more study is needed to determine whether the current treatment guidelines are relevant for the oldest mesothelioma patients.
Linton, A, et al, “Patterns of care and survival of older patients with malignant pleural mesothelioma”, March 24, 2019, Journal of Geriatric Oncology, Epub ahead of print, https://www.geriatriconcology.net/article/S1879-4068(18)30425-9/fulltext