Management of malignant pleural mesothelioma: a French multicenter retrospective study (GFPC 0802 study)

Abstract

BackgroundMalignant pleural mesothelioma (MPM) is a rare disease with poor prognosis in spite of significant improvement in survival, due to new chemotherapy regimens. We describe here patients’ profiles and management in daily practice in France.MethodsObservational retrospective study. Data were collected from medical files. All patients with histologically proven MPM diagnosed from January 2005 to December 2008 were included in the participating sites.ResultsFour hundred and six patients were included in 37 sites: mean age 68.9 ± 9.8 years, male predominance (sex ratio 3.27), latency of the disease 45.7 years, epithelioïd type 83 %. Diagnosis was made using thoracoscopy in 80.8 % of patients. Radical surgery was performed in 6.2 % of cases. Chemotherapy was administered to 74.6 % of patients. First line regimens consisted mainly of platinum + pemetrexed (91 %) or pemetrexed alone (7 %). Objective response rate was 17.2 % and another 41.6 % of patients experienced disease stabilization. Half of these patients underwent second line chemotherapy (platinium + pemetrexed 31.6 %, pemetrexed alone 24.6 %), resulting in a 6 % response rate. Third-line chemotherapy (56 patients) yielded disease control in 5.4 % of cases.ConclusionsThe management of MPM in France is usually in accordance with guidelines. Response rates are somewhat lower than those described in clinical trials.

Systemic Therapy Use and Outcomes After Relapse from Preoperative Radiation and Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma

“…ORR to first‐line systemic therapy was lower than reported rates in both clinical trials and retrospective series . Such low response rates and poor OS led us to question whether aggressive multimodality therapy favors the emergence of more resistant clonal populations at relapse.…”

“…In patients who are not candidates for resection, median OS is approximately 12–16 months in clinical trials of first‐line platinum doublet chemotherapy and 18 months with the addition of bevacizumab . OS otherwise ranges from 9 to 12 months in retrospective series of patients treated with platinum‐based doublets in a real‐world setting with chemotherapy delivered in 62% of patients, surgery ± radiation in 7.7%, and combination of surgery and chemotherapy ± radiation in 19.5% .…”

NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016

“…The 3 combination regimens include (1) cisplatin/pemetrexed (category 1), (2) carboplatin/pemetrexed, and (3) cisplatin/gemcitabine. [34][35][36][37][38][39][40][41][42][43][44][45] Pemetrexed-based regimens are typically used, with gemcitabine recommended only for patients who cannot receive pemetrexed. These 3 combination regimens can also be used as adjuvant therapy for patients as part of multimodality therapy.…”

Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis

“…Extra‐pleural pneumonectomy preceded by neoadjuvant chemotherapy and followed by hemithorax irradiation has almost been abandoned in routine practice in France . Treatment of advanced MPMs relies primarily on chemotherapy with combination platinum and pemetrexed and, more recently, bevacizumab .…”