Inclusion of anti-vascular therapy as a promising option for later-line treatment of malignant pleural mesothelioma: a retrospective study

Our plain-English summary of Inclusion of anti-vascular therapy as a promising option for later-line treatment of malignant pleural mesothelioma: a retrospective study, by K. Shao, D. Wu, Q. Wang, et al (Journal of Thoracic Disease, 2025).

The study

• Authors: K. Shao, D. Wu, Q. Wang, D. Wang, Y. Hao, B. Li, J. Huang, Z. Yang, J. Wu, L. Huang, W. Li, R. Meng, J. Feng, J. Fu, H. Feng, S. Yang, L. Xu, X. Shi, M. Li, Y. Wang, C. Xu, Z. Song
• Journal: Journal of Thoracic Disease
• Published: 2025;17(8):5687-5697
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a highly aggressive malignancy with a poor prognosis. While pemetrexed-based chemotherapy and dual immunotherapy are established first-line treatments, optimal second- and later-line therapies remain underexplored. This study aims to evaluate later-line treatment options for MPM.

Methods: We retrospectively evaluated the outcomes of 85 patients with MPM who had failed in the first-line treatment between 2006 and 2023 in six hospitals. Survival outcomes were analyzed using Kaplan-Meier methodology, with between-group comparisons performed via log-rank testing. The Cox proportional hazards model was employed for both univariate and multivariate analyses to identify prognostic factors. Treatment response was assessed using standard efficacy endpoints: objective response rate (ORR) and disease control rate (DCR).

Results: This retrospective analysis evaluated 85 patients with advanced MPM. The cohort demonstrated a median progression-free survival (PFS) of 3.73 months and a median overall survival (OS) of 12.4 months. In the later-line, combining chemotherapy with anti-vascular therapy showed significant efficacy in median PFS than the chemotherapy scheme (4.57 vs. 3.00 months, P=0.004), as well as differences in median OS (13.00 vs. 10.03 months, P=0.04).

Conclusions: For patients with MPM requiring later-line treatment, the combination of chemotherapy and anti-vascular therapy may represent a viable therapeutic alternative, demonstrating an acceptable safety profile.

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In plain English

This retrospective study from six Chinese hospitals covered 85 patients, treated 2006 to 2023, with advanced (stage III or IV) malignant pleural mesothelioma after failed first-line treatment. It compared later-line chemotherapy alone (34 patients) with chemotherapy plus an anti-vascular drug, either bevacizumab, apatinib or anlotinib (51 patients). Asbestos exposure was not reported. Across all 85 patients, median progression-free survival was 3.73 months (95% CI 3.29–4.18) and median overall survival 12.40 months (95% CI 9.72–15.08). Median progression-free survival was 4.57 months with the combination versus 3.00 months (95% CI 2.66–3.34) with chemotherapy alone (P=0.004). The combination group's printed interval (3.29–4.18) excludes its own median. Median overall survival was 13.00 months (95% CI 10.29–15.71) versus 10.03 months (95% CI 6.44–13.63) (P=0.04). The combination group had 63 side effects, 8 of them grade 3 to 4, in 6 patients. Six patients stopped because of toxicity, and none died from drug toxicity. The authors concluded the combination may be a viable later-line option. They noted possible bias from the retrospective design and a need for prospective studies. Other figures in the article also disagree.

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 multicenter study (six hospitals) comparing two groups defined by their second- or later-line treatment
• Who was studied: 85 patients with clinically advanced (stage III or IV) malignant pleural mesothelioma whose first-line treatment had failed, treated at six hospitals in China between May 6, 2006 and June 5, 2023; median age 53 years (range 13–78)
• Exposure: The exposure studied was treatment, not asbestos: second- or later-line chemotherapy alone (34 patients) versus chemotherapy plus an anti-vascular (antiangiogenic) drug, either bevacizumab, apatinib or anlotinib (51 patients). Asbestos exposure of the patients was not reported.
• Main results:
  • Whole cohort (85 patients): median progression-free survival 3.73 months (95% CI 3.29–4.18); median overall survival 12.40 months (95% CI 9.72–15.08)
  • Whole cohort: objective response rate 12.5% and disease control rate 83.3% (denominators not given)
  • Median progression-free survival was 3.00 months in the chemotherapy-only group vs 4.57 months in the chemotherapy plus anti-vascular group (P=0.004)
  • Figure 1, progression-free survival: 95% CI 2.66 to 3.34 for the chemotherapy-only group. For the combination group the interval is printed as 3.29 to 4.18, which does not contain its own median of 4.57 months and duplicates the whole-cohort interval.
  • Median overall survival was 13.00 months in the chemotherapy plus anti-vascular group vs 10.03 months in the chemotherapy-only group (P=0.04)
  • Figure 1, overall survival: 95% CI 10.29 to 15.71 months for the combination group and 6.44 to 13.63 months for the chemotherapy-only group
  • In multivariate Cox analysis of progression-free survival, only treatment mode (chemotherapy alone vs combination) was statistically significant (HR 0.425; 95% CI 0.251–0.720; P=0.001). Sex was significant only in the univariate analysis.
  • Among anti-vascular drugs, bevacizumab (a monoclonal antibody) vs small-molecule drugs (apatinib, anlotinib): progression-free survival 4.80 vs 3.93 months (P=0.57, not significant); overall survival 19.00 vs 10.00 months (P=0.009)
  • In the 51 patients given anti-vascular therapy, 63 adverse events were recorded. 55 of 63 were grade 1–2 and 8 of 63 (12.7%) were grade 3–4, occurring in 6 patients. Six patients stopped because of toxicity, and no patient died from drug toxicity.
• The authors' conclusion: The authors concluded that, for patients with malignant pleural mesothelioma needing later-line treatment, chemotherapy combined with anti-vascular therapy may be a viable alternative with an acceptable safety profile
• Limitations the authors state:
  • Retrospective design, which may introduce inherent biases
  • No in-depth pathological subgroup analysis
  • Prospective studies are needed to confirm the results

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Pemetrexed (Alimta), Chemotherapy, Immunotherapy, Progression-Free Survival, Median Overall Survival.

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