Chemotherapy in addition to surgery buys malignant mesothelioma patients extra time, and multimodal treatment increases survival even more. These benefits are independent of the surgical method used, suggesting that multiple treatment approaches should be considered in mesothelioma.
The study, “Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)–Medicare investigation of treatment patterns and overall survival,” was published in the journal Clinical Epidemiology.
For patients diagnosed with mesothelioma, the type of treatment offered is usually based on the clinical stage and cell subtype of the cancer. Since treatment data is rarely evaluated, researchers at Wayne State University School of Medicine in Michigan performed a review of treatment data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare data files.
The research team included 1,625 patients in the study who were diagnosed with either pleural or peritoneal malignant mesothelioma from January 1, 2005 and December 31, 2009. The median age at diagnosis was 78 years, but ages ranged from 66 to 103 years. A vast majority of patients were white men.
Nearly half of the group, 44.7 percent, received some form of chemotherapy. Analyses showed that those who were treated with such therapy were significantly younger at the time of diagnosis. They were also white, married, and lived in areas with higher educations and income levels.
Patients receiving chemotherapy were also more likely to have mesothelioma of stage 2, 3, or 4 at diagnosis, and less likely to have other diseases. These patients had a median overall survival (OS) of 12 months, compared to a median of only four months in those not treated with chemotherapy.
Patients who were treated with both surgery and several lines of chemotherapy lived for a median of 16 months. Analyses showed that an extra round of chemotherapy (second-line therapy) gave the patients five additional months. Patients who continued maintenance treatment with Alimta (pemetrexed) after finishing chemotherapy treatment containing Alimta survived for a median of 12 months.
These differences were mirrored in the proportion of patients alive after one year; 48 percent of those who received chemotherapy (both with and without surgery) were still alive, compared to 17 percent of untreated patients.
An even higher proportion, 61 percent, of those who had both surgery and chemotherapy lived after one year, while 42 percent of patients treated who did not have surgery were alive after one year.
“To our knowledge, this is one of the first population-based studies of treatment patterns for mesothelioma describing the impact of treatment on OS,” the researchers wrote.
“In conclusion, mesothelioma patients receiving some form of chemotherapy survived longer than patients who did not, regardless of surgery, with an additional survival benefit among those patients receiving multimodal treatment.”