Malignant pleural mesothelioma (MPM) in elderly patients: A multicenter survey.

Abstract

7082 Background: The incidence of malignant pleural mesothelioma (MPM) in elderly patients (pts) is increasing in Western countries. Elderly pts with MPM are under-represented in clinical trials, and there are no specific guidelines for their management. The aim of this study was to perform a retrospective survey on this patient population in four Oncology Departments with high MPM accrual and expertise. Methods: The clinical records of elderly pts (≥70 years old) with MPM referred to the participating centers from January 2005 to November 2011 were reviewed. For each patient, age and gender, histology, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI) and treatment modalities were collected. The study endpoint was overall survival (OS). Results: Out of a total of 610 cases, 210 elderly pts were identified (34% of the whole MPM population observed in the study period). Pts characteristics were: median age 75 yrs (range 70-92), M/F 132/78, epithelial/non-epithelial histology 140/70, ECOG-PS 0/1/2/unknown 130/67/9/4. CCI was 0 in 128 pts (61%), ≥4 in 59 pts (28%). Treatment was multimodality therapy including surgery in 16, chemotherapy in 153 (73%) and best supportive care only in 41 pts (19%). Chemotherapy was mainly pemetrexed-based. Median OS was 11.3 months. Non-epithelial histology, age ≥75 yrs and the presence of comorbidities (CCI ≥1, p=.003; CCI ≥4, p<0.0001) were significantly correlated to a shorter OS. Conclusions: Pemetrexed-based chemotherapy is feasible in selected elderly pts with MPM. Comorbidity is a significant prognostic factor, and should be carefully considered in patient selection. Prospective dedicated trials in elderly pts with MPM selected according to comorbidity scales are warranted.