Virtual Library
Start Your Search
Esmond D Nwokeji
Author of
-
+
P1.06 - Mesothelioma (ID 169)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
-
+
P1.06-13 - Treatment Patterns and Outcomes in Advanced Malignant Pleural Mesothelioma: Surveillance, Epidemiology, and End Results Data (Now Available) (ID 834)
09:45 - 18:00 | Author(s): Esmond D Nwokeji
- Abstract
Background
Malignant pleural mesothelioma (MPM) is a rare neoplasm with poor prognosis. With only one approved systemic treatment (Tx) for advanced disease in first-line (1L), pemetrexed with a platinum agent, the objective of this study is to understand patterns of care and overall survival (OS).
Method
This retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims included patients aged ≥ 66 years with a primary diagnosis (Dx) of MPM between 2007–2013 (followed through 2014). Treated patients who received chemotherapy as 1L within 90 days of Dx, second-line (2L), or third-line (3L) therapy were identified. We used Kaplan-Meier product limit estimator for OS.
Result
Of 1556 patients with MPM, 666 had advanced MPM. Of patients with advanced MPM, 82% were male, 87% white, 78% had AJCC Stage IV, and 70% had no mobility limitation indicators (eg oxygen tank use) at Dx. Chemotherapy for advanced MPM was received by 262 (39%) patients in 1L, 106 (16%) in 2L, and 29 (4%) in 3L. Of 1L patients, 209 (80%) received standard of care (SOC) pemetrexed with platinum (other 1L regimens included pemetrexed monotherapy; gemcitabine and vinorelbine). Of the 209 patients, 41% (n = 86) initiated 2L therapy, of whom 26% (n = 22) initiated 3L. Within 90 days of Dx, 52% of patients visited an emergency department, 78% were hospitalized, and 21% had hospice care. Common 2L therapies were gemcitabine and pemetrexed (alone or in combination); 3L regimens included vinorelbine and gemcitabine. Median OS for all patients was 7.2 months and 10.7 months for 1L (table).
Unadjusted OS and Tx Duration
ConclusionCohort*
N
Median OS
(months; 95% CI)1-Year Survival (95% CI)
2-Year Survival
(95% CI)Median Tx Duration (days; IQR)
Dx
666
7.2
(6.6–8.2)0.34
(0.30–0.38)0.14
(0.11–0.17)NR
1L
209
10.7
(9.6–12.0)0.43
(0.36–0.50)0.15
(0.11–0.22)84 (42–136)
2L
86
5.3
(4.0–7.0)0.22
(0.14–0.33)0.04
(0.01–0.13)55 (33–102)
3L
22
4.9
(3.8–7.3)NR
NR
52 (24–77)
*1L, 2L, 3L include only 1L pemetrexed + platinum
This study highlights the significant unmet need in advanced MPM. Low Tx rates and poor overall survival were observed for all patient groups, suggesting patients may benefit from additional tx options.
-
+
P2.06 - Mesothelioma (ID 170)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.06-04 - Treatment Patterns and Outcomes of Advanced Malignant Pleural Mesothelioma (MPM) Patients in a Community Practice Setting (Now Available) (ID 723)
10:15 - 18:15 | Author(s): Esmond D Nwokeji
- Abstract
Background
MPM is an aggressive neoplasm with a poor prognosis and limited therapeutic options. Pemetrexed+platinum is standard of care (SOC) for advanced MPM in the United States with cisplatin doublet as the only approved first-line (1L) treatment by the Food and Drug Administration (FDA). There are no FDA approved treatments in second-line (2L) or later. Understanding how patients are currently treated and the associated outcomes is important to assess the unmet needs in MPM.
Method
Retrospective data were abstracted from the US Oncology Network’s iKnowMed electronic health record (EHR) for patients with advanced MPM receiving systemic therapy between 01-Jan-2008 and 31-Dec-2016, followed through 31-Dec-2017. Eligibility criteria: ≥18 years of age, ≥2 visits, no clinical trial enrollment or other malignancy during study period. Baseline demographic/clinical characteristics, treatment patterns, duration of chemotherapy (DOT) and overall survival (OS) were assessed, using Kaplan-Meier methods for 1L, 2L+ survival.
Result
474 advanced MPM patients receiving treatment were identified; median age was 72 years, majority were male (82%) with an Eastern Cooperative Oncology Group (ECOG) score of 0 to 1 (71%). Cisplatin+pemetrexed (n=194; 41%) and carboplatin+pemetrexed (n=175; 37%) were the most frequent 1L regimens, followed by pemetrexed monotherapy (n=51; 11%). Only 108 (23%) patients received 2L and 33 (7%) received 3L. The most common 2L regimens included monotherapies gemcitabine (n=40; 37%), pemetrexed (n=27; 25%), vinorelbine (n=9; 8%), and IO therapy (avelumab, nivolumab or pembrolizumab n=9; 8%). Median DOT was 2.7 months in 1L SOC and 1.7 months in all 2L regimens. Unadjusted median OS in patients 1L SOC was 14.0 months (95%CI, 11.6-17.0) with similar survival observed among cisplatin+pemetrexed (13.7 months; 95%CI, 10.8-18.5) and carboplatin+pemetrexed (14.2 months; 95%CI, 11.1-19.8); OS for 1L pemetrexed monotherapy (10.7 months; 95%CI,6.2-14.3). Unadjusted OS in 2L was 6.4 months (95%CI, 5.1-7.6) ranging from 3.4 months (95%CI, 2.7-6.5) with gemcitabine to 11.8 months (95%CI, 0.3-NR) with immunotherapies.
Conclusion
This real-world analysis of advanced MPM showed a majority of 1L patients received SOC pemetrexed+platinum based therapy, with carboplatin almost as common as cisplatin. The platinum agent paired with pemetrexed in 1L SOC did not affect unadjusted survival in the community setting. Less than a quarter of 1L patients received a 2L therapy, with gemcitabine as the most common treatment. Overall survival in MPM remains poor and treatment rates in 2L are low, highlighting the need for more effective therapies.
