The newest study on real-world mesothelioma patients illustrates the need for more ways to treat this devastating cancer.
Many studies focus on a carefully-chosen subset of patients. Patients have to meet specific guidelines to qualify for a mesothelioma clinical trial.
But the authors of a new report in Future Oncology focused on real-world mesothelioma patients in community clinics. The goal was to see what kinds of treatments these patients got and how well they worked.
The results show most people do not have other treatments after first-line therapy. They also suggest that mesothelioma doctors and patients need new first-line alternatives.
First- and Second-Line Mesothelioma Therapies
Malignant mesothelioma is the name for cancer on the membranes around internal organs. Pleural mesothelioma occurs on the membrane around the lungs. Peritoneal mesothelioma occurs on the membrane around the abdomen. Pericardial mesothelioma occurs on the tissue that surrounds the heart.
The majority of real-world mesothelioma patients get the pleural variety. Like all types of mesothelioma, the cause is usually exposure to asbestos.
Chemotherapy with pemetrexed (Alimta) is the recommended first-line mesothelioma treatment. Patients usually receive a combination of Alimta and a platinum drug like cisplatin or carboplatin. If the cancer comes back after treatment, patients can have more chemotherapy.
Evaluating the Treatment of Real-World Mesothelioma Patients
The new study included 469 real-world mesothelioma patients with advanced cancer. Researchers gathered information about these past cases from cancer databases.
As expected, most patients received pemetrexed first. About half of patients had pemetrexed combined with cisplatin. The other half had a combination with carboplatin. The results were similar for both.
The median overall survival for these real-world mesothelioma patients was 12 months. The researchers say only a few patients got second- or third-line therapies. Patients who did get second-line chemotherapy lived about 6.4 months after treatment.
The team concludes that real-world mesothelioma patients need more mesothelioma treatment options.
“There is a need for more effective systemic anticancer therapies (SACTs) for advanced malignant pleural mesothelioma,” writes study author David Waterhouse, MD, of Oncology Hematology Care in Cincinnati.
In 2020, the FDA approved the first new systemic therapy for advanced mesothelioma since 2004. It is a combination of the immunotherapy drugs nivolumab and ipilimumab. Other immunotherapy regimens are under investigation.
Waterhouse, D, et al, “Treatment patterns and outcomes of patients with advanced malignant pleural mesothelioma in a community practice setting”, March 26, 2021, Future Oncology, Online ahead of print, https://www.futuremedicine.com/doi/10.2217/fon-2021-0047