Efficacy of second-line treatment and prognostic factors in patients with advanced malignant peritoneal mesothelioma: a retrospective study

Our plain-English summary of Efficacy of second-line treatment and prognostic factors in patients with advanced malignant peritoneal mesothelioma: a retrospective study, by R. Kitadai, T. Shimoi, K. Sudo, et al (BMC Cancer, 2021).

The study

• Authors: R. Kitadai, T. Shimoi, K. Sudo, E. Noguchi, Y. Nagata, R. Sawada, A. Takashima, N. Boku, K. Yonemori
• Journal: BMC Cancer
• Published: 2021;21(1):294
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Standard treatment for malignant peritoneal mesothelioma has not been established, and systemic chemotherapy is administered according to malignant pleural mesothelioma. We previously reported the efficacy of cisplatin plus pemetrexed as first-line chemotherapy; however, the efficacy of second-line chemotherapy remains unknown.

Methods: We retrospectively evaluated patients with malignant peritoneal mesothelioma who started first-line systemic chemotherapy with platinum plus pemetrexed between March 2007 and February 2019 at the National Cancer Center Hospital. Patients who received second-line chemotherapy after failure of platinum plus pemetrexed were identified. We evaluated the efficacy of first- and second-line chemotherapy, and explored the prognostic factors. Survival outcomes were estimated using the Kaplan-Meier method, and between-group differences were compared using the log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazards models.

Results: A total of 54 and 26 patients received platinum plus pemetrexed as first- and second-line chemotherapy, respectively (gemcitabine in 12 patients; taxane, six; nivolumab, three; and others, five). In all patients, the median overall survival and progression-free survival after first-line chemotherapy were 16.6 and 7.3 months, respectively. Among patients who received second-line chemotherapy, the median overall survival, progression-free survival, and second-line overall survival were 16.9, 3.2, and 9.9 months, respectively. Patients who received ≥6 cycles of platinum plus pemetrexed as first-line chemotherapy had longer overall survival after second-line chemotherapy than those who did not (hazard ratio, 0.23; 95% confidence interval: 0.06-0.82; p = 0.02).

Conclusions: Second-line chemotherapy may be an option for refractory malignant peritoneal mesothelioma, especially in patients who have completed 6 cycles of platinum plus pemetrexed as first-line chemotherapy.

In plain English

This retrospective study reviewed medical records of 54 patients with malignant peritoneal mesothelioma (mesothelioma of the abdominal lining). They began first-line platinum plus pemetrexed (cisplatin in all but one) between March 2007 and February 2019 at the National Cancer Center Hospital, Tokyo. Fifteen (27.7%) had a history of obvious asbestos exposure. For all 54, median overall survival from starting first-line chemotherapy was 16.6 months (95% confidence interval, CI, 11.7 to 36.7). Twenty-six received second-line treatment after first-line failure, most often gemcitabine (12). In these 26, median survival from the start of second-line treatment was 9.9 months (95% CI 4.8 to not assessed), and median progression-free survival was 3.2 months (95% CI 0.9 to 14.9). Those who had received 6 or more first-line cycles lived longer after second-line treatment than those with fewer: median 10.2 versus 1.8 months, hazard ratio 0.23 (95% CI 0.06 to 0.82). Asbestos exposure was not significantly associated with survival after second-line treatment. The authors noted the study was small, retrospective and single-hospital. They concluded second-line chemotherapy may be an option, especially after 6 completed first-line cycles.

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: single-institution retrospective study of medical records
• Who was studied: 54 patients with histologically proven malignant peritoneal mesothelioma who started first-line platinum plus pemetrexed between March 2007 and February 2019 at the National Cancer Center Hospital, Tokyo, Japan. 26 of them received second-line chemotherapy.
• Exposure: The exposure studied was treatment: first-line cisplatin or carboplatin plus pemetrexed (53 cisplatin, 1 carboplatin), followed in 26 patients by second-line gemcitabine, a taxane, nivolumab or other agents. A history of asbestos exposure was recorded, but no fiber types or doses were reported.
• Main results:
  • A history of obvious asbestos exposure was recorded in 15 (27.7%) of the 54 patients.
  • All 54 patients: median overall survival after first-line chemotherapy was 16.6 months (95% CI 11.7 to 36.7).
  • The 26 second-line patients received gemcitabine (12), a taxane (6), nivolumab (3) or others (5).
  • The 26 second-line patients: median progression-free survival from the start of second-line chemotherapy was 3.2 months (95% CI 0.9 to 14.9).
  • The 26 second-line patients: median overall survival from the start of second-line chemotherapy was 9.9 months (95% CI 4.8 to not assessed).
  • Among second-line patients, median survival after second-line treatment was 10.2 months in those who completed 6 cycles of first-line chemotherapy and 1.8 months in those who did not.
  • In multivariate analysis (adjusted for age and distant metastasis), 6 or more first-line cycles were independently associated with longer second-line overall survival: HR 0.23 (95% CI 0.06 to 0.82), p = 0.02.
  • Age, sex, obvious asbestos exposure, histology, ECOG performance status and distant metastasis were not significantly associated with second-line overall survival. For asbestos exposure (8 exposed vs 18 not exposed or unknown) the HR was 2.00 (95% CI 0.68 to 5.87), p = 0.2.
  • Median overall survival from first-line chemotherapy was 16.9 months in patients who received second-line chemotherapy and 15.0 months in those who received first-line chemotherapy only. The difference was not statistically significant (p = 0.99).
  • No treatment-related deaths occurred with second-line chemotherapy.
• The authors' conclusion: The authors concluded that second-line chemotherapy may be an option for refractory malignant peritoneal mesothelioma, especially in patients who completed 6 cycles of first-line platinum plus pemetrexed.
• Limitations the authors state:
  • The study was done at a single institution, and the sample was too small to evaluate each regimen accurately.
  • Because the study was retrospective and patient backgrounds were not well balanced, the regimens could not be compared.
  • The adverse event data, collected retrospectively, were insufficient.
  • Malignant peritoneal mesothelioma has few target lesions, so tumour response could not be adequately assessed.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Chemotherapy, Pleural Mesothelioma, Cisplatin, Pemetrexed (Alimta), Gemcitabine, Nivolumab (Opdivo), Median Overall Survival.

Related studies

• Analysis of prognostic factors of patients with malignant peritoneal mesothelioma — W. Yin, G. Zheng, et al. (2018)
• Second-line chemotherapy in malignant pleural mesothelioma: results of a retrospective multicenter survey — P.A. Zucali, M. Simonelli, et al. (2012)
• Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis — D. Magge, M.S. Zenati, et al. (2014)
• Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study — J. Hommell-Fontaine, S. Isaac, et al. (2013)
• Prognostic factors of malignant peritoneal mesothelioma: a retrospective study of 52 female patients — J. Ma, S. Zhang (2022)
• The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study — S. Takamori, G. Toyokawa, et al. (2018)

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