Efficacy, Safety, and Cost-Minimization Analysis of Continuous Infusion of Low-Dose Gemcitabine Plus Cisplatin in Patients With Unresectable Malignant Pleural Mesothelioma.

Oscar Arrieta,Silvia Guzmán Vázquez,Andrés F Cardona,Maritza Ramos-Ramírez,Jenny G Turcott,Sae Muñiz-Hernández,Herman Soto-Molina,Feliciano Barrón,Rodrigo Catalán,Luis Cabrera-Miranda,Osvaldo Díaz-Álvarez,Saul Campos,Wendy Muñoz-Montaño,Victor Martínez-Pacheco

doi:10.3389/fonc.2021.641975

Abstract

BackgroundMalignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; furthermore, the monetary cost of its treatment represents a major challenge for many patients. The economic burden this malignancy imposes is underscored by the fact that asbestos exposure, which is the most frequent risk factor, is much more prevalent in the lower socioeconomic population of developing countries. The aims of the present study were to evaluate the efficacy, safety, and cost of continuous infusion of low-dose Gemcitabine plus Cisplatin (CIGC) as a treatment strategy for patients with unresectable MPM.MethodsWe performed a prospective cohort study to determine efficacy and safety of continuous infusion gemcitabine at a dose of 250 mg/m2 in a 6-h continuous infusion plus cisplatin 35 mg/m2 on days 1 and 8 of a 21-day cycle in patients with unresectable MPM. We also performed a cost-minimization analysis to determine if this chemotherapy regimen is less expensive than other currently used regimens.ResultsThe median number of chemotherapy cycles was six (range 1–11 cycles); objective response rate was documented in 46.2%, and disease control rate was seen in 81.2%. Median PFS was 8.05 months (CI 95% 6.97–9.13); median OS was 16.16 months (CI 95% 12.5–19.9). The cost minimization analysis revealed savings of 66.4, 61.9, and 97.7% comparing CIGC with short-infusion gemcitabine plus cisplatin (SIGC), cisplatin plus pemetrexed (CP), and cisplatin plus pemetrexed and bevacizumab (CPB), respectively. Furthermore, this chemotherapy regimen proved to be safe at the administered dosage.ConclusionCIGC is an effective and safe treatment option for patients with unresectable MPM; besides, this combination is a cost-saving option when compared with other frequently used chemotherapy schemes. Therefore, this treatment scheme should be strongly considered for patients with unresectable MPM and limited economic resources.

Highlights

Malignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; the monetary cost of its treatment represents a major challenge for many patients
Due to the low incidence of MPM, we consider that results derived from this cohort (80 patients) should be enough to conclude that our treatment efficacy is similar to other strategies approved by FDA (CP or cisplatin plus pemetrexed and bevacizumab (CPB)) for patients with unresectable MPM
The EMPHACIS trial was the pivotal study that led to the FDA approval of PC as first-line therapy for patients with unresectable MPM; this study reported an objective response rate (ORR) of 41.3% and a median Progression free survival (PFS) and overall survival (OS) of 5.7 and 12.1 months [21]

Summary

Introduction

Malignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; the monetary cost of its treatment represents a major challenge for many patients The economic burden this malignancy imposes is underscored by the fact that asbestos exposure, which is the most frequent risk factor, is much more prevalent in the lower socioeconomic population of developing countries. Malignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; the monetary cost of its treatment represents a major challenge for many patients [1,2,3] The incidence of this malignancy varies widely among countries; this variation might be explained by the heterogeneous usage of asbestos, which is a well-known risk factor for developing MPM [4].

Objectives

Methods

Results

Discussion

Conclusion