New Mesothelioma Study Results

Between August 2001 and July 2002, a total of 42 patients with malignant pleural mesothelioma (MPM) were enrolled in a Phase I study that involved extrapleural pneumonectomy (EPP) and intraoperative hyperthermic cisplatin (IOHC). IOHC is heated cisplatin that is delivered into the cavity created during surgery when the mesothelioma and associated organs are removed. Intravenous administration of the drug amifostine was also used to try to ameliorate the cisplatin-induced renal toxicity.

During thoracotomy, 13 patients were found to have unresectable disease and 29 patients had their MPM resected to smaller than 1 centimeter. Of the latter group, there were 22 men and 7 women patients, with a median age of 57 years. Here are the results of the study:

Overall

17 months = median survival for the 42 patients enrolled in the protocol, both those with resectable disease and those with unresectable disease.

Unresectable Disease

10 months = median survival for the 13 patients with unresected disease.

Patients Who Underwent EPP

20 months = median survival for the 29 patients who underwent EPP resection.

Epithelial versus Non-Epithelial

Twenty-four patients had epithelial disease, and 5 patients had non-epithelial tumors.

29 months = median survival for the 24 patients who underwent resection of epithelial tumors.

13 months = median survival for the 5 patients with non-epithelial tumors who underwent resection.

Epithelial and Stage

29 months = median survival of those patients with resected disease of epithelial type and stage 1 to 2 disease.

15 months = median survival of those patients with resected disease of epithelial type and stage 3 disease.

Cisplatin Chemotherapy

26 months = median survival for the 15 patients with resected disease who received higher cisplatin doses.

16 months = median survival for the14 patients with resected disease who received lower cisplatin doses.

Surgical Margins – A negative surgical margin means that no cancer cells were found on the outer edge of the removed tissue, and is a sign that no cancer was left behind. A positive surgical margin indicates that cancer cells are found at the outer edge of the removed sample and is usually a sign that some cancer remains in the body.

30 months = median survival for the 10 patients with resected disease with negative surgical margins.

17 months = median survival for the 19 patients with resected disease and positive surgical margins.

Extrapleural Lymph Nodes – lymph nodes outside the pleura.

31 months = median survival for the 20 patients with resected disease without mesothelioma in the extrapleural lymph nodes.

14 months = median survival for the 9 patients with resected disease with mesothelioma in the extrapleural lymph nodes.

Stage Alone

35 months = median survival for the 18 patients with resected disease and stage 1 to 2 disease.

14 months = median survival for the 11 patients with resected disease and stage 3 disease.

Conclusion

The authors of the study concluded that, “Early stage and negative extrapleural lymph nodes were associated with prolonged survival.”

Note: The staging is based on the model developed by Brigham and Women’s Hospital–Dana-Farber Cancer Institute

Source: Zellos L, et al., A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2009 Feb;137(2):453-8.