Characteristics and long‐term outcomes of advanced pleural mesothelioma in Latin America (MeSO‐CLICaP)

Abstract

Background Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population. Methods The MeSO‐CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first‐line chemotherapy among Latin American patients. Results The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first‐line platinum‐based chemotherapy. The overall response rate to first‐line chemotherapy was 40.4%, progression‐free survival to first‐line treatment was 5.7 months (95% CI 4.9–6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0–20.5), and multivariate analysis found that stage ( P = 0.013), and pleurodesis ( P = 0.048), were independent prognostic factors for first‐line overall survival. The model to predict response to first‐line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non‐responders. Conclusion This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.

Mesothelioma: Scientific clues for prevention, diagnosis, and therapy

“…Very recently, South America's largest mesothelioma study reported some characteristics of 302 pleural mesotheliomas from Argentina, Brazil, Colombia, Costa Rica, Panama, Mexico, Peru, Nicaragua, and Venezuela . The median patient age at diagnosis was 61.1 years, 63.2% of patients were men, 78.5% had epithelioid mesotheliomas, 38.7% had previous exposure to asbestos, 62.3% had stage III disease, and 37.7% had stage IV disease .…”

“…Very recently, South America's largest mesothelioma study reported some characteristics of 302 pleural mesotheliomas from Argentina, Brazil, Colombia, Costa Rica, Panama, Mexico, Peru, Nicaragua, and Venezuela . The median patient age at diagnosis was 61.1 years, 63.2% of patients were men, 78.5% had epithelioid mesotheliomas, 38.7% had previous exposure to asbestos, 62.3% had stage III disease, and 37.7% had stage IV disease . Compared with patients who had mesotheliomas in the United States and Europe, these Latin American patients were younger, the M:F ratio and the percentage of patients exposed to asbestos were lower, and, surprisingly, median survival was significantly longer than in the United States and Europe despite the advanced stages of all 302 patients.…”

Mesothelioma in a developing country: a retrospective analysis of the diagnostic process

“…Em 2019, foi publicado o maior estudo observacional sobre o mesotelioma na AL, incluindo 302 pacientes de nove países/centros diferentes. (7) A análise concentrou-se na taxa global de resposta à quimioterapia de primeira linha e em fatores relacionados à sobrevida livre de progressão. Embora o estudo (7) tenha fornecido informações fundamentais sobre características clínicas e patológicas, ele compilou dados de países com características distintas, como sistemas de saúde diversos e diferentes tipos de fibras de amianto a que as populações foram expostas.…”

“…(7) A análise concentrou-se na taxa global de resposta à quimioterapia de primeira linha e em fatores relacionados à sobrevida livre de progressão. Embora o estudo (7) tenha fornecido informações fundamentais sobre características clínicas e patológicas, ele compilou dados de países com características distintas, como sistemas de saúde diversos e diferentes tipos de fibras de amianto a que as populações foram expostas. (5) Até o momento, o presente estudo é o maior estudo observacional no Brasil avaliando características clínicas e patológicas do MPM.…”

Incidence and Risk Factors of Chest Wall Metastasis at Biopsy Sites in Patients with Malignant Pleural Mesothelioma

“…As recommended by the guidelines, pleurodesis is commonly performed in patients with malignant pleural effusion (MPE) [ 13 ]. Pleurodesis helps in not only controlling pleural effusion-related symptoms in MPM but also improving the prognosis [ 34 , 35 ]. Moreover, pleurodesis has been performed in patients who are candidates for P/D because visceral pleurectomy may be easier in patients with complete pleural adhesion [ 16 ].…”