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Marley Boyd



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    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
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      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): Marley Boyd

      • Abstract
      • Slides

      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.

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