A Real-World Analysis of the Use of Systemic Therapy in Malignant Pleural Mesothelioma and the Differential Impacts on Overall Survival by Practice Pattern

The Role of Real-World Evidence to Support Treatment Choices in Malignant Pleural Mesothelioma

“…Although these three findings do not substantively alter current views of managing MPM, one can consider how the research platform used by Kerrigan et al. 1 can appraise and inform treatment paradigms.…”

“…In this issue of JTO Clinical and Research Reports , Kerrigan et al. 1 report outcomes from patients diagnosed with having malignant pleural mesothelioma (MPM) who received at least one line of pemetrexed-based chemotherapy. They describe the prescribing patterns with specific interest in the following: the platinum analog used in combination with pemetrexed as first-line treatment (no difference observed between cisplatin and carboplatin); whether maintenance pemetrexed prolongs survival (also not observed); and finally, in patients who received subsequent lines of therapy, whether immunotherapy was more efficacious than chemotherapy (no statistically significant difference found here either).…”

“…The use of the Flatiron database by Kerrigan et al. 1 showcases some of the strengths and weaknesses of the Flatiron platform. They were able to report relatively current information on 787 patients with MPM who were treated with platinum-based chemotherapy, a significant feat in a rare disease.…”

“…The dataset for the study of Kerrigan et al. 1 covered the period from January 2011 to July 2019. The study findings support the recommendations made in the ASCO guideline for treatment of MPM that was published in 2018.…”

“…In the second-line setting, Professor Dean Fennell in 2021 presented or published the results of two important studies, the topic of one of the main questions asked by the RWE data presented by Kerrigan et al. 1 First, the CONFIRM study randomized patients with advanced MPM, previously treated with platinum-based chemotherapy, to either nivolumab or placebo and revealed a significantly prolonged OS with nivolumab. 13 Second, Professor Fennell reported the VIM study of vinorelbine plus active supportive care versus active supportive care alone and concluded that (despite prolongation of progression-free survival, but not OS) this could be considered an appropriate off-label use of chemotherapy.…”