A gentle therapy: Weekly epirubicin, as second-line treatment in elderly patients with malignant pleural mesothelioma (MPM).

Abstract

9053 Background: MPM is a rapidly progressive tumor with a poor prognosis. Treatment options are limited for patients (pts) with PMP who experience disease progression after first-line pemetrexed-based chemotherapy (CT). This retrospective study wants to evaluate, in the age of immunotherapy, whether a gentle CT can be used as second line of treatment in elderly pts, above all maintaining quality of life (safety and tolerability ) and improving progession free survival (PFS ). Currently second-line CT is increasingly use, because many elderly pts are fit at the progression of the disease. No standard second/further line CT exist for MPM after failure of first-line pemetrexed based CT. The purpose of the study is to evaluate the clinical activity of weekly epirubicin as second-line CT in elderly with MPM. Methods: From July 2015 to March 2019, in Medical Oncology Dept. of ASST Rhodense 98 pts were elegible for analysis. Pts had histologically confermed unresectable MPM. Histology was epithelioid in 86 pts, sarcomatoid in 7 and biphasic in 5 pts. A Carboplatin(AUC4)-pemetrexed doublet was administered in 70 pts and 28 received gemcitabine as single agent how first line. A quality of life questionnaire was administered to each pt and geriatric comprehensive assessment (GCA) was performed. Epirubicin ( E ) was always administered with a schedule at 20 mg/msq day 1,8,15 every 28 until disease progression or intolerance. The primary endpoint was PFS, and secondary endpoints were the overall response rate (ORR) and QofL an overall survival (OS). Results: Of the 98 elegible pts, 71 was males, and 27 was female . Median age: 78 (range 72-86) PS: 0/1/2 was respectively in 32%, 60% and 8% of pts. A median of 5 cycles of E (range 2 -16) was delivered; 3% of pts required dose modification. PFS was of 7 months (range 3-16) . ORR was as follow: 0 CR, 18 PR (17%), 44 SD (44%) and PD occurred in 36 pts (39%). OS was 11 months (range 5-22). No life threatening event occurred. No grade 3-4 toxicities were observed . Liver toxicity grade 1-2in 10 pts (10%), thrombocytopenia grade 1 in 9 pts (9%), neutropenia grade 1-2 in 40 pts (40%), fatigue grade 2 in 33pts (32%), nausea grade 1 in 20 pts (20%). The analitical and stratified data will be exposed. Conclusions: Also in the era of immunotherapy, a simple treatment, E in weekly schedule has demonstrated to be a gentle therapy with a possibility to treat in second line, pre-treated elderly pts with MPM in progression after first line therapy, with an acceptable profile . Now this schedule could be considered as a safe and standard secon-line CT in elderly pts.