Three Decades of Malignant Pleural Mesothelioma: An Academic Center Experience

• Published in: Clinical lung cancer Vol. 22; no. 5; pp. 441 - 448
• Main Authors: Nasser, Abdullah, Baird, Andrew, Saint-Pierre, Mathieu D., Amjadi, Kayvan, Laurie, Scott, Wheatley-Price, Paul
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2021
• Subjects: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Catheters; Databases, Factual; Demographics; Female; Humans; Male; Mesothelioma, Malignant - drug therapy; Mesothelioma, Malignant - surgery; Middle Aged; Pemetrexed; Pneumonectomy; Retrospective Studies; Survival; Survival Analysis; Young Adult; Demographics; Pneumonectomy; Pemetrexed; Survival; Catheters
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2021.03.011

Malignant pleural mesothelioma (MPM) remains a challenging disease to manage. In the past few decades, extrapleural pneumonectomy (EPP), pemetrexed-based chemotherapy, and indwelling pleural catheters were introduced to MPM care with variable levels of efficacy and evidence. This was a retrospective review of patients diagnosed with MPM between January 1991 and March 2019. The primary outcome was overall survival (OS). Data were examined by decade to assess trends in MPM demographics, management, and OS. A subgroup analysis was then conducted to examine the impact of EPP, pemetrexed, and indwelling pleural catheters on OS. The study included 337 patients; 309 patients had died at last follow-up (91.7%). Median age at diagnosis and the proportion of female patients increased from 65.8 years (interquartile range [IQR], 57.1-73.7) and 11.6% female from 1991 to 1999 to 75 years (IQR, 68.1-80.6) and 20.5% female from 2010 to 2019. Median OS was largely unchanged in the three study periods: 9.0 months (95% confidence interval [CI], 6.9-12.7) in the 1991-1999 cohort, 9.3 months (95% CI, 7.6-13.2) in the 2000-2009 cohort, and 10.1 months (95% CI, 7.9-13.6) in the 2010-2019 cohort. Controlling for a number of demographic and prognostic factors, EPP (hazard ratio [HR] = 0.50; 95% CI, 0.3-0.9; P = .02), pemetrexed-based chemotherapy (HR = 0.59; 95% CI, 0.40-0.87; P = .007), and indwelling pleural catheters (HR = 0.3; 95% CI, 0.13-0.71; P = .006) were each associated with improvements in OS. Despite the small incremental improvements in survival shown by the three interventions we examined, prognosis remains guarded for MPM patients. Better modalities of management are needed. Malignant pleural mesothelioma (MPM) is a rare disease that has had few changes in management over the past few decades. This is a retrospective review of 337 MPM patients. We found that MPM patients are increasingly more likely to be older and female. Extrapleural pneumonectomy, pemetrexed-based chemotherapy, and indwelling pleural catheters were each associated with improved overall survival based on real-life data.