There are three standard treatments for malignant pleural mesothelioma. Patients and doctors want to know which is more effective.
A new study from the Davidoff Cancer Center in Israel sought to do just that. This study compared three clinical trials of the standard treatments recommended for malignant mesothelioma. All three treatments involved different chemotherapy drugs.
Treatment A was cisplatin plus pemetrexed vs cisplatin. Treatment B was cisplatin plus pemetrexed plus bevacizumab vs cisplatin plus pemetrexed. And Treatment C was nivolumab plus ipilimumab vs cisplatin plus pemetrexed.
Urgent Need to Identify Effective Treatment Strategies
Malignant pleural mesothelioma is the primary cancer of the pleural lining. It is caused by exposure to asbestos. It affected more than 30,000 patients globally in 2020.
The prognosis is usually poor. Patient survival is approximately 12 months from diagnosis. Current standard treatments have only modestly improved patient survival.
There is an urgent need to identify new and effective treatment strategies. Since 2003, three different treatment strategies have been tested via clinical trials. These three treatment strategies are considered “frontline” therapies.
Each new treatment was designed to replace the previous therapy because of presumed better performance.
First, chemotherapy with two drugs: cisplatin and pemetrexed. It was replaced by chemotherapy with three drugs: cisplatin and pemetrexed plus the antiangiogenic bevacizumab. The third one was nivolumab plus ipilimumab. This latest strategy was recently approved by the US Food and Drug Administration.
There is a limited increase in survival benefits for each of these standard treatments. A new study performed a deeper analysis of the clinical trial designs and outcomes of these three treatments. Their goal was to understand how they truly benefit patients with malignant pleural mesothelioma.
Cost-Effectiveness Ratios for Approved Therapies
The comparison showed no superiority of Treatment C over Treatment B. But, all three clinical trials needed more patients to draw stronger conclusions.
The cost-effectiveness ratio of approved standard treatments is also debated. The estimated drug cost for cisplatin plus pemetrexed is $46,225 for 6 cycles. The cost for nivolumab plus ipilimumab is approximately $153,800 for 4 cycles. This shows the need to consider the best treatment options with greater care.
These high-cost cancer drugs are currently being appraised by national health agencies.
A recent analysis recommended 10 drugs for coverage by the national health system. But all 10 drugs included a financial agreement to improve cost-effectiveness. And seven were subject to more evidence for efficacy.
The present study showed that more clinical trial evidence was needed for clinical decision-making policies.
First Comparative Effectiveness Study for Mesothelioma Treatments
This is the first comparative effectiveness study on the three clinical trials and showed that the results of these clinical trials are not as clear as we hoped. More research is needed for the frontline treatments. Only then can doctors assess its real impact before it is approved for patients.
Meirson, Tomer, Francesca Pentimalli, Francesco Cerza, Giovanni Baglio, Steven G. Gray, Pierpaolo Correale, Marija Krstic-Demonacos et al. “Comparison of 3 randomized clinical trials of frontline therapies for malignant pleural mesothelioma.” JAMA Network Open 5, no. 3 (2022): e221490-e221490. http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2022.1490