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M.W. Onaitis



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    MA 19 - Mesothelioma: Bench to Bedside (ID 680)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Mesothelioma
    • Presentations: 1
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      MA 19.09 - The Role of Neoadjuvant Chemotherapy in Patients with Malignant Pleural Mesothelioma (ID 10187)

      11:00 - 12:30  |  Author(s): M.W. Onaitis

      • Abstract
      • Presentation
      • Slides

      Background:
      The treatment of localized malignant pleural mesothelioma (MPM) involves multimodality therapy, however, there is no standard of care with respect to operative procedure and timing of chemotherapy. We analyzed data from a single institution to identify whether the use of pemetrexed-platinum neoadjuvant chemotherapy impacts survival.

      Method:
      Patients with histologically-proven MPM who had surgery from 1996 to 2016 were identified. Follow-up was complete for a median of 24 months. Survival was calculated from time of diagnosis to last follow up or death. Univariate and multivariate Cox proportional hazards were used.

      Result:
      From 1996 to 2016 we identified 376 patients. Mean age was 66+/-8 years and 54 (14%) were female. There was no difference in survival for pleurectomy/decortication or extrapleural pneumonectomy. Neoadjuvant chemotherapy significantly improved survival compared to surgery followed by chemotherapy (table 1). Multivariate analysis was significantly associated for increased survival for epithelioid histology, T-status, node positivity, and neoadjuvant chemotherapy (table 2).

      Table 1. Univariate Analysis
      Variable (n) Median survival (mo.) P value
      Gender Male (322) Female (54) 13.6 17.2 P=0.043
      Histology Epithelial (252) Mixed (91) Sarcomatoid (26) 18.3 12.1 6.5 P<0.0001
      T stage T 1-2 (33) T 3-4 (343) 42.6 14.3 P=0.0002
      N status N 0 (129) N 1-2 (113) 23.1 11.3 P<0.0001
      Neoadjuvant chemotherapy Yes (153) No (223) 19.8 11.3 P<0.0001
      Table 2. Cox Proportional Hazards Model
      Covariate Hazard Ratio 95% CI p-value
      Histology (ref: Epithelioid) Biphasic Sarcomatoid ref 1.66 4.24 [ref] [1.17-2.36] [1.77-10.1] ref 0.005 0.001
      T-status 3-4 vs 1-2 3.07 [1.32-7.15] 0.009
      Node-positivity 1.93 [1.40-2.66] <0.001
      Neoadjuvant chemotherapy 0.65 [0.47-0.91] 0.011
      Cox proportional hazards model including histology, t-status, n-status, and neoadjuvant chemotherapy C-index: 0.69

      Conclusion:
      Our results suggest that neoadjuvant chemotherapy increases survival and likely enhances the complete resection rate. These data are being evaluated in a multi-institutional cohort of five major mesothelioma programs in North America to improve guidelines for mesothelioma therapy.

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