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Mesothelioma Survival May Depend on the Timing of Chemotherapy

5201844_patient16People with one of the rarer subtypes of mesothelioma may live longer if they have chemotherapy as soon as possible after their mesothelioma surgery.

That is the finding of an international team of mesothelioma researchers studying the timing of mesothelioma chemotherapy. Their new report has just been published in the prestigious journal, Lung Cancer.

Chemotherapy for Mesothelioma

Most patients diagnosed with malignant mesothelioma will have chemotherapy during the course of their treatment. A combination of pemetrexed (Alimta) and cisplatin is the primary first-line treatment for the asbestos cancer.

However, the timing of chemotherapy can vary widely, particularly in patients who also undergo mesothelioma surgery. Neo-adjuvant chemotherapy is administered prior to mesothelioma surgery in an effort to reduce tumor size for more complete removal. Adjuvant chemotherapy is given after surgery as a way to kill mesothelioma cells left behind.

Extending Mesothelioma Survival

To test what impact the timing of chemotherapy has on mesothelioma survival, the research team led by Dr. Annabel J. Sharkey at University Hospitals Leicester analyzed the postoperative outcomes of 229 malignant pleural mesothelioma patients.

Eighty-one of the study participants had radical lung-removing mesothelioma surgery (EPP) while the rest had extended pleurectomy-decortication (EPD) which leaves the lungs intact.

In people with epithelioid mesothelioma, the most common subtype, the timing of chemotherapy did not seem to affect survival. But in people suffering from either sarcomatoid or biphasic mesothelioma, in whom mesothelioma cells had spread to their lymph nodes, timing mattered.

“Delaying chemotherapy until evidence of disease progression in patients with non-epithelioid disease had a detrimental effect on overall survival (OS), and on progression free survival (PFS) in lymph node positive patients,” writes Dr. Sharkey, a cardiothoracic surgeon and lead author of the report.

First-Line Chemotherapy Patients

When the team extended their study to include 169 mesothelioma patients who received chemotherapy as their first-line treatment (prior to any surgery), the sickest non-epithelioid patients lived longer if their post-surgical treatment was not delayed.

“Our results suggest that the timing of additional chemotherapy may be important in those with a poorer prognosis on the basis of cell type and nodal stage,” concludes the report. “In these patients, additional postoperative chemotherapy should not be delayed.”

Mesothelioma patients and their families should consult with their physicians on the best chemotherapy regimen for their unique situation.


Sharley, AJ, et al, “How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma”?, October 2016, Lung Cancer, Epub ahead of print

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