Researchers have developed a three-factor tool to predict which malignant mesothelioma patients with relapses are likely to have better outcomes and which poorer outcomes.
One benefit of the prognosis tool for those whose disease has returned is that it should help physicians identify patients fit enough to participate in Phase 1 clinical trials, the research team said.
Although the assessment tool was able to sort out patients with better and poorer prognoses, researchers said more studies are needed to validate it.
The study, “Clinical outcomes and prognostic factors of patients with advanced mesothelioma treated in a phase I clinical trials unit,” was published in the journal European Journal of Cancer.
The development of the tool was built on previous work by researchers at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research in the United Kingdom.
Since the hospital has a clinical trials unit, researchers developed a disease scoring tool first. The Royal Marsden Hospital prognostic score (RPS) can help doctors select patients whose conditions are suitable for early trials.
Many cancers spread across the body as the disease advances, but until its last stages, mesothelioma usually stays in the mesothelium, or abdominal, heart and chest cavities.
Doctors have little information on treatment options for patients who have a relapse shortly after they have received their first-line treatment. To better assess which relapsed mesothelioma patients to include in trials, researchers examined the records of 65 patients who had participated in 38 Phase 1 trials.
Progression-free survival in the group averaged 2 1/2 months, and overall survival eight months. Only 6 percent, or four patients, had a partial response according to the RECIST (Response Evaluation Criteria In Solid Tumors) scale. Forty percent of the patients’ disease was stable for more than three months.
Analyses showed that three factors could be used to create a mesothelioma prognosis scale, which the team named m-RPS. Researchers gave each factor that was present in patient a score of 1.
One factor was a higher than 3 to 1 ratio of immune cells called neutrophils to lymphocytes. Another was more than two disease sites. The third was low blood levels of the albumin protein. Researchers counted all lymph nodes as one site.
The study showed that patients with a score of 0 or 1 had triple the overall survival rate — 13.4 months — than patients with a score of 2 to 3, whose rate was four months.
