Efficacy of chemotherapy for malignant pleural mesothelioma according to histology in a real-world cohort

Our plain-English summary of Efficacy of chemotherapy for malignant pleural mesothelioma according to histology in a real-world cohort, by S. Cedres, J.D. Assaf, P. Iranzo, et al (Scientific Reports, 2021).

The study

• Authors: S. Cedres, J.D. Assaf, P. Iranzo, A. Callejo, N. Pardo, A. Navarro, A. Martinez-Marti, D. Marmolejo, A. Rezqallah, C. Carbonell, J. Frigola, R. Amat, A. Pedrola, R. Dienstmann, E. Felip
• Journal: Scientific Reports
• Published: 2021;11(1):21357
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

CheckMate 743 trial demonstrated survival benefit of immunotherapy in first line in MPM with some differences in the efficacy of chemotherapy according to histology. The objective of this study is to characterize the impact of chemotherapy according to histology in patients diagnosed with MPM at our institution. Clinical records of all MPM patients diagnosed at Vall d'Hebron University Hospital between November 2002 and April 2020 were reviewed. Associations between clinical variables and outcomes were assessed with Cox regression models. Survival data were calculated by the Kaplan-Meier method. 189 patients were included with 76% of tumors classified as epithelioid subtype. First line chemotherapy was offered to 85% of patients. Median survival in overall population was 21.3 months (95% CI 17.2-24.3). We found that patients with epithelioid tumors had better overall survival (OS) and progression free survival (PFS). Median OS of epithelioid patients treated with first line chemotherapy was 26.7 months versus 15.0 months in non-epithelioid patients (HR 2.25 CI 95% 1.4-3.4; p < 0.001). Median PFS for patients with epithelioid tumors treated with chemotherapy was 4.8 months versus 3.6 months in non-epithelioid (HR 1.5 CI 95% 1.0-2.3; p = 0.03). The improvement of outcomes in patients with epithelioid histology was detected in patients treated with cisplatin or carboplatin. Histology was not a predictive factor for the platinum agent sensitivity (p of interaction PFS = 0.09, p of interaction OS = 0.65). In our series, patients with non-epithelioid tumors presented worse prognosis. Although epithelioid tumors exposed to cisplatin had higher PFS, histology was not a clear predictor of chemotherapy efficacy.

© 2021. The Author(s).

In plain English

This retrospective cohort study reviewed the records of 189 patients with malignant pleural mesothelioma treated at Vall d'Hebron University Hospital in Barcelona, Spain. It looked at whether chemotherapy results differed by tumor type (histology). There were 145 epithelioid, 17 sarcomatoid, 14 biphasic and 13 unspecified tumors, and 75% of patients had previous asbestos exposure. In all, 161 patients received chemotherapy, mostly cisplatin or carboplatin plus pemetrexed. Median survival for the whole group was 21.3 months (95% confidence interval 17.2 to 24.3 months). Among patients given first-line chemotherapy, median overall survival was 26.7 months for epithelioid tumors versus 15.0 months for non-epithelioid tumors. Median progression-free survival (time until the disease worsened or death) was 4.8 versus 3.6 months. The survival difference by histology appeared with both cisplatin and carboplatin. However, the study found no statistically significant interaction between histology and the choice of platinum drug. No statistically significant survival differences were detected by asbestos exposure, sex or smoking. The authors concluded that histology is a prognostic factor, with worse survival for non-epithelioid tumors. They noted the study came from one hospital and included few non-epithelioid patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study using real-world hospital medical records
• Who was studied: 189 consecutive patients aged 18 or older with confirmed malignant pleural mesothelioma who received at least one line of therapy at Vall d'Hebron University Hospital, Barcelona, Spain (methods give February 2002 to February 2020). Median age was 68 and 70% were male. Tumors were 145 epithelioid, 17 sarcomatoid, 14 biphasic and 13 not specified.
• Exposure: The study compared treatment outcomes by tumor histology. 161 patients (85%) received chemotherapy. In first line, 134 received platinum plus pemetrexed: 102 received cisplatin plus pemetrexed and 32 received carboplatin plus pemetrexed. Asbestos exposure history was recorded as a clinical variable.
• Main results:
  • 75% of patients in the cohort had previous asbestos exposure.
  • Median survival of the entire group of 189 patients was 21.3 months (95% CI 17.2 to 24.3 months).
  • Across all patients, median survival was 21.3 months for epithelioid versus 9.6 months for non-epithelioid tumors (HR 2.4, 95% CI 1.6 to 3.4, p less than 0.001).
  • No statistically significant survival differences were detected by gender, smoking or asbestos exposure (p greater than 0.05).
  • In patients treated with first-line chemotherapy, median overall survival was 26.7 months for epithelioid tumors versus 15.0 months for non-epithelioid tumors (HR 2.25, 95% CI 1.4 to 3.4, p less than 0.001).
  • In patients treated with first-line chemotherapy, median progression-free survival was 4.8 months for epithelioid versus 3.6 months for non-epithelioid tumors (HR 1.5, 95% CI 1.0 to 2.3, p = 0.03).
  • With cisplatin plus pemetrexed, median overall survival was 30.7 months for epithelioid versus 17.2 months for non-epithelioid patients (HR 2.7, 95% CI 1.6 to 4.5, p less than 0.001).
  • With first-line carboplatin plus pemetrexed, median overall survival was 26.7 months for epithelioid versus 14.8 months for non-epithelioid patients (HR 2.7, 95% CI 1.3 to 5.8, p = 0.008).
  • Within each drug group, the progression-free survival differences by histology were not statistically significant. With cisplatin it was 5.1 versus 3.6 months (HR 1.4, 95% CI 0.91 to 2.3, p = 0.11). With carboplatin it was 4.5 versus 3.6 months (HR 1.99, 95% CI 0.96 to 4.1, p = 0.06).
  • The Cox model interaction test between histology and platinum agent was not statistically significant (overall survival p interaction = 0.65; progression-free survival p interaction = 0.09).
  • The objective response rate to chemotherapy was 38% in epithelioid and 22% in non-epithelioid tumors.
  • Among all patients treated in first line, median survival was 23.1 months with cisplatin plus pemetrexed versus 16.4 months with carboplatin plus pemetrexed (HR 0.4, 95% CI 0.3 to 0.7, p less than 0.001).
  • Among 27 patients given immunotherapy in second or later lines, median overall survival was 28.3 months for epithelioid versus 13.8 months for non-epithelioid patients (HR 3.4, 95% CI 1.3 to 8.7, p = 0.01). No difference in progression-free survival by histology was detected in this group.
• The authors' conclusion: The authors concluded that histology is a prognostic factor: patients with non-epithelioid tumors had worse survival, and patients with epithelioid tumors had better progression-free survival. Because there was no significant interaction between platinum agent and histology, they suggested that histology is not a determinant of platinum agent sensitivity.
• Limitations the authors state:
  • The series came from a single institution.
  • The number of non-epithelioid patients was small.
  • The proportion of epithelioid patients was high (76%).
  • Tumor samples came from both surgery and image-guided biopsies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Histology, CheckMate 743, Immunotherapy, Epithelioid, Median Overall Survival, Overall Survival.

Related studies

• Maintenance pemetrexed after platinum pemetrexed chemotherapy and survival outcomes in malignant pleural mesothelioma in a multicenter real world study — O. Aydin, Z.S. Isleyen, et al. (2026)
• Follow-up after first-Line nivOlumab plus ipilimumab in patients with diffuse pleuRal mesotheliomA: a real-world Dutch cohort study-FLORA — L.H. Douma, M.M. Hofman, et al. (2025)
• Expression of TILs and Patterns of Gene Expression from Paired Samples of Malignant Pleural Mesothelioma (MPM) Patients — S. Cedres, G. Serna, et al. (2023)
• Correlation between TS, MTHFR, and ERCC1 gene polymorphisms and the efficacy of platinum in combination with pemetrexed first-line chemotherapy in mesothelioma patients — T. Powrózek, D.M. Kowalski, et al. (2014)
• Efficacy and safety of an intensified schedule of tremelimumab for chemotherapy-resistant malignant mesothelioma: an open-label, single-arm, phase 2 study — L. Calabrò, A. Morra, et al. (2015)
• Analysis of mismatch repair (MMR) proteins expression in a series of malignant pleural mesothelioma (MPM) patients — S. Cedrés, S. Ponce-Aix, et al. (2020)

Browse more research in Scientific Reports, or return to medical research.