Abstract
BackgroundStandard treatment for malignant peritoneal mesothelioma has not been established, and systemic chemotherapy is administered according to malignant pleural mesothelioma. We previously reported the efficacy of cisplatin plus pemetrexed as first-line chemotherapy; however, the efficacy of second-line chemotherapy remains unknown.MethodsWe retrospectively evaluated patients with malignant peritoneal mesothelioma who started first-line systemic chemotherapy with platinum plus pemetrexed between March 2007 and February 2019 at the National Cancer Center Hospital. Patients who received second-line chemotherapy after failure of platinum plus pemetrexed were identified. We evaluated the efficacy of first- and second-line chemotherapy, and explored the prognostic factors. Survival outcomes were estimated using the Kaplan–Meier method, and between-group differences were compared using the log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazards models.ResultsA total of 54 and 26 patients received platinum plus pemetrexed as first- and second-line chemotherapy, respectively (gemcitabine in 12 patients; taxane, six; nivolumab, three; and others, five). In all patients, the median overall survival and progression-free survival after first-line chemotherapy were 16.6 and 7.3 months, respectively. Among patients who received second-line chemotherapy, the median overall survival, progression-free survival, and second-line overall survival were 16.9, 3.2, and 9.9 months, respectively. Patients who received ≥6 cycles of platinum plus pemetrexed as first-line chemotherapy had longer overall survival after second-line chemotherapy than those who did not (hazard ratio, 0.23; 95% confidence interval: 0.06–0.82; p = 0.02).ConclusionsSecond-line chemotherapy may be an option for refractory malignant peritoneal mesothelioma, especially in patients who have completed 6 cycles of platinum plus pemetrexed as first-line chemotherapy.
Highlights
Standard treatment for malignant peritoneal mesothelioma has not been established, and systemic chemotherapy is administered according to malignant pleural mesothelioma
Few studies have been conducted on malignant peritoneal mesothelioma (MPeM), and systemic chemotherapy recommended for the treatment of malignant pleural mesothelioma (MPlM) is widely used
Second-line chemotherapy using various agents was administered to some patients
Summary
Standard treatment for malignant peritoneal mesothelioma has not been established, and systemic chemotherapy is administered according to malignant pleural mesothelioma. Malignant mesothelioma is a rare malignancy arising from mesothelial cells of the pleura, peritoneum, pericardium, and tunica vaginalis testis [1]. The vast majority arise from the pleura, and malignant peritoneal mesothelioma (MPeM) accounts for approximately 15– 20% of all cases [2], which is the second most frequent primary site. Because of the rarity of the disease, no standard treatment has been established based on randomised controlled trials. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have been shown to improve survival. Not all patients with MPeM are suitable for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Few studies have been conducted on MPeM, and systemic chemotherapy recommended for the treatment of malignant pleural mesothelioma (MPlM) is widely used
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