Researchers at one of the nation’s top cancer centers have identified what they believe are key prognostic factors for people with malignant pleural mesothelioma who are not candidates for surgery.
Mesothelioma Surgery Versus Chemotherapy
Because pleural mesothelioma is such a difficult disease to treat, combatting it usually requires a combination of several therapies.
Patients who are candidates for surgery may have chemotherapy or radiation prior to surgery in an effort to reduce the size of their mesothelioma tumor. After surgery, they may have more chemotherapy to keep mesothelioma cells from seeding new tumors.
But not all mesothelioma patients stand to benefit from surgery. Mesothelioma tumors can be challenging to remove because of their irregular shape and the mesothelioma surgery itself is physically taxing.
After the approval of the mesothelioma drug Alimta (pemetrexed) in 2004, more mesothelioma patients were able to receive chemotherapy as their primary treatment.
Out-of-Date Mesothelioma Prognosis?
Because surgery was once considered the primary treatment for mesothelioma, early prognostic scoring systems for mesothelioma included patients who were treated surgically.
But researchers at Memorial Sloan Kettering Cancer Center in New York say these prognostic scoring systems are out of date because they don’t take into account that many modern mesothelioma patients are now being treated primarily with chemotherapy.
Modernizing Prognostic Scoring for Mesothelioma Patients
In an effort to make the prognostic scoring system more accurate for today’s patients, the team analyzed the cases of 191 Memorial Sloan Kettering patients diagnosed with pleural mesothelioma between 2000 and 2013.
More than three-quarters of the group were men and the average age of the studied patients was 71.
Eighty-two percent of the mesothelioma patients in the analysis had either Stage III or Stage IV mesothelioma. Most had the epithelioid histological subtype.
Predicting Mesothelioma Outcomes
By analyzing mesothelioma patients who were not candidates for surgery, the team was able to both validate some parts of the current prognostic scoring systems and offer some new insights.
When multiple mesothelioma prognostic factors were taken into account, the team found that only histology (epithelioid, sarcomatoid or biphasic), platelet count and performance status (a measure of overall health) were independent prognostic factors.
In addition, having the epithelioid type of mesothelioma, having a performance status of 0 to 1 at diagnosis, and having an elevated lymphocyte count at diagnosis were “significantly associated with clinical benefit from first-line chemotherapy.”
The findings were presented late last year at a meeting of the International Association for the Study of Lung Cancer and appear in a recent issue of the Journal of Thoracic Oncology.
Source: Bille, A, et al, “Contemporary Analysis of Prognostic Factors in Patients with Unresectable Malignant Pleural Mesothelioma”, February 2016, Journal of THoracic Oncology, pp. 249-255