A new multi-institutional study reveals that the application of a trimodal treatment, including chemotherapy, radiotherapy and surgery, for Mesothelioma treatment carries risks for the patient’s health that might be not worth taking in light of the unsatisfactory benefits that come from this strategy. The research paper, untitled “Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial),” was published in the International Journal of Clinical Oncology.
A team of Japanese researchers from specialized Oncology centers at different Japanese Universities enrolled 42 patients with malignant pleural mesothelioma (MPM) and no prior treatment for the disease in their study. Pleural mesothelioma is a rare form of cancer that affects the pleura, the membrane lining of the lungs. It is the most common form of mesothelioma cancers, accounting for about 75% of all cases diagnosed in the U.S, according to the Pleural Mesothelioma Center, and is a very aggressive, difficult to treat disease due to its resistance to conventional therapies. Different combinations of therapies are used to treat patients and there is still no consensus regarding which combination presents the best alternative for patients.
In light of this question, researchers aimed to evaluate if the trimodal strategy of chemotherapy, extrapleural pneumonectomy (EPP, a surgical procedure), and post-surgical radiation was the best or at least a fairly successful option. The patients underwent chemotherapy for tumor reduction, EPP procedure and hemithoracic post-operative radiation, followed by evaluation of the primary endpoints of the study, macroscopic complete resection (MCR) rate for EPP and treatment-related mortality for the trimodal treatment. Results show that of the 42 patients, 30 individuals achieved MCR while 4 died from treatment-related complications. The overall median survival time for all of the enrolled patients was 19.9 months, while 2-year survival was achieved by 42.9% of the patients.
The researchers conclude that despite some promising results from some of the patients in the study and achievement of primary endpoints, the observed benefits do not justify the risk of the treatment, affirming that the trimodal treatment strategy risk/benefit ratio was not satisfactory. Alex Strauss, Managing Editor of Surviving Mesothelioma, said of the study results in a press release, “Most mesothelioma patients will undergo some combination of treatments. As this study indicates, the jury is still very much out on exactly what combination is most effective in terms of mesothelioma survival.”