Efficacy, Safety, and Cost-Minimization Analysis of Continuous Infusion of Low-Dose Gemcitabine Plus Cisplatin in Patients With Unresectable Malignant Pleural Mesothelioma

Abstract

BackgroundMalignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; furthermore, the monetary cost of its treatment represents a major challenge for many patients. The economic burden this malignancy imposes is underscored by the fact that asbestos exposure, which is the most frequent risk factor, is much more prevalent in the lower socioeconomic population of developing countries. The aims of the present study were to evaluate the efficacy, safety, and cost of continuous infusion of low-dose Gemcitabine plus Cisplatin (CIGC) as a treatment strategy for patients with unresectable MPM.MethodsWe performed a prospective cohort study to determine efficacy and safety of continuous infusion gemcitabine at a dose of 250 mg/m2 in a 6-h continuous infusion plus cisplatin 35 mg/m2 on days 1 and 8 of a 21-day cycle in patients with unresectable MPM. We also performed a cost-minimization analysis to determine if this chemotherapy regimen is less expensive than other currently used regimens.ResultsThe median number of chemotherapy cycles was six (range 1–11 cycles); objective response rate was documented in 46.2%, and disease control rate was seen in 81.2%. Median PFS was 8.05 months (CI 95% 6.97–9.13); median OS was 16.16 months (CI 95% 12.5–19.9). The cost minimization analysis revealed savings of 66.4, 61.9, and 97.7% comparing CIGC with short-infusion gemcitabine plus cisplatin (SIGC), cisplatin plus pemetrexed (CP), and cisplatin plus pemetrexed and bevacizumab (CPB), respectively. Furthermore, this chemotherapy regimen proved to be safe at the administered dosage.ConclusionCIGC is an effective and safe treatment option for patients with unresectable MPM; besides, this combination is a cost-saving option when compared with other frequently used chemotherapy schemes. Therefore, this treatment scheme should be strongly considered for patients with unresectable MPM and limited economic resources.

Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma

“… 29 Most of the existing economic studies on MPM focused on chemotherapy. 30 – 32 In 2012, Woods et al ., on the basis of the results of the EORTC08983 trial, used an indirect comparison method to evaluate the relative efficacy of raltitrexed combined with cisplatin and pemetrexed combined with cisplatin. They concluded that raltitrexed in combination with cisplatin was an economical first-line treatment for patients with MPM.…”

PD-L1 expression complements CALGB prognostic scoring system in malignant pleural mesothelioma

“…Furthermore, survival outcomes predicted for different CALGB groups in this study were slightly different from those previously reported in different cohorts, which may be attributed to variations in their therapeutic management ( 25 ). In this regard, our cohort underwent standard treatment with cisplatin and pemetrexed, but better clinical outcomes have been described in previous evidence by combining chemotherapy with bevacizumab ( 19 ), pembrolizumab ( 26 ), gemcitabine as continuous infusion ( 27 ), liposomal doxorubicin ( 28 ), or substituting it with ipilimumab plus nivolumab ( 6 ). In contrast, lack of benefit has been identified in unresectable epithelioid MPM after monotherapy with CTLA-4 ( 29 ) as second-line of treatment or VEGF ( 30 ) blockers as first-line approach.…”

Malignant Pleural Mesothelioma

“…The loss of the BAP1 protein is a common occurrence in mesothelioma, particularly in the epithelioid/biphasic subtypes, often linked to homozygous BAP1 deletion. BAP1 immunostaining from pleural fluid serves as an outstanding biomarker, exhibiting a 100% specificity in distinguishing between benign and malignant mesothelial proliferations [52,53], making it a valuable rule in test.…”

“…Gemcitabine, when combined with a platinum compound like cisplatin, carboplatin, or oxaliplatin, has undergone extensive testing in numerous phase II studies, showing variable response rates with acceptable toxicity levels [70][71][72]. Arrieta et al [52] highlighted its efficacy, safety, and cost-effectiveness, particularly noting that Gemcitabine plus cisplatin is a viable and safe treatment for patients with unresectable MPM [47]. Carboplatin is an alternative when cisplatin is unsuitable.…”