Pleural mesothelioma patients who undergo aggressive multimodal treatment live nearly twice as long after diagnosis than those who do not, according to a recent extensive study.
Researchers at MD Anderson Cancer Center in Texas found a combination of surgery, chemotherapy and radiation extended survival time significantly, regardless of disease histology or cancer stage.
“We recommend that all patients with [malignant pleural mesothelioma] be evaluated by multidisciplinary teams that are experienced in the management of mesothelioma for consideration of surgery-based, multimodality treatment,” the authors wrote. “Well selected patients seem to benefit from aggressive therapy.”
The Journal of Clinical Oncology published the study Aug. 17. The research team utilized the National Cancer Database, a hospital-based nationwide registry that represents an estimated 70 percent of newly-diagnosed cancer cases in the U.S.
Trimodal Treatment Works
The study started with 20,561 mesothelioma patients identified from 2004 to 2014. Of those, 6,645 were used in a matching cohort, separated into surgical and non-surgical groups.
Among the findings, overall median survival was:
- 8 months for those undergoing trimodal treatment (surgery, chemotherapy and radiation).
- 9 months for those undergoing surgery
- 5 months for patients having no surgery
Patients with the epithelial histology of mesothelioma fared the best with a median survival of 23.4 months, compared to just 13.7 months for those not having surgery.
Those with biphasic histology went from a median survival of 8.1 months without surgery to 13.9 months with the trimodal treatment approach.
Sarcomatoid histology — the most hard to treat — had a median survival of 10.8 months with trimodal treatment, compared to just 5.1 months for patients not having surgery.
The use of trimodal treatment showed a survival advantage regardless of lymph node involvement and at each cancer stage. It also provided a clear contrast to the less aggressive treatment plans many patients still pursue.
“The greatest estimated treatment effect on survival was observed when cancer-directed surgery, chemotherapy and radiation therapy were combined, which underscores the importance of trimodality therapy,” the authors wrote.
Researchers included medical oncologist Dr. Anne Tsao — director of MD Anderson’s highly-regarded mesothelioma program — thoracic surgeons Dr. David Rice and Dr. Boris Sepesi, and radiation oncologist Dr. Daniel Gomez.
“On subgroup analysis, surgery based multimodality therapy shows the greatest survival advantage,” they wrote. “Despite its aggressive nature, currently available therapeutic modalities seem to result in improved survival.”
Downside to Surgery
Although surgery had its advantages, the study also noted 30-day and 90-day mortality rates of 6.3 percent and 15.5 percent, respectively, for those undergoing procedures.
The authors used those numbers to emphasize the need for patients to find a center with experience treating mesothelioma.
“The 15 percent, 90-day mortality is high and underscores the importance of careful patient selection, meticulous operative and perioperative care, and experience with this type of treatment,” they wrote.
Among the patients in the study, 2,166 received no therapy, 2,015 received only chemotherapy and 274 were able to complete the trimodal regimen. There were 850 patients who received only surgery.
The number of patients receiving no therapy was in line with the recent National Cancer Institute study that reported a 29 percent no-therapy rate.
A vast majority of patients in the MD Anderson study who received no treatment were older than 70, a trend that goes against other recent studies showing age should not be a determining factor in the choice to have surgery.
“More and more, we’ve come to realize that age is just a number,” thoracic surgeon Dr. Mark Berry at the Stanford University Medical Center told Asbestos.com recently.
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