Salvage treatment in patients with recurrent or resistant malignant pleura mesothelioma. A retrospective study from tertiary oncology department

Abstract

Introduction: The platinum- pemetrexed doublet is the golden standard for the first line chemotherapy in Malignant Mesothelioma (MM) . As a result of very often relapse, second line chemotherapy choice is crucial for patients survival. Methods: A number of 98 patients with MM, treated in a tertiary Oncology Unit were reviewed and analyzed. Results: 50 patients (86%M/ 14%F, median age 66 years, 74% PS 0-1, 98% pleural MM, 82,93% with epithelial histology) received second line chemotherapy, resulting in 6,25% PR, 25% SD, 31,25% DC and 56,25% PD Median PFS of 3,02 months (95%CI 2,72- 4,89), 18,98 months mOS (95%CI 16,16- 23,09) and 6,93 months median survival from the start of second line (95%CI 5,02- 10,38). 48% of patients (24) received a taxane– gemcitabine with 0% PR, 21,74% SD, 21,74% DC, 69,57% PD, 2,98m mPFS (95%CI 2,59-3,38), 15,34m mOS (95%CI 11,43- 20,50) and 5,88m m2LS (95%CI 2,85- 8,41). 18% (9) had docetaxel monotherapy. None of them had achieved PR, and 55,56% progressed resulting in 3,02m mPFS (95%CI 0,78- 9,39), 22,96m mOS (95%CI 6,99- ) and 5,48m m2LS (95%CI 0,88- ). Finally 8 patients (16%) received the third most common second line option,with pemetrexed doublet (6/ 12%) or pemetrexed monotherapy (2/ 4%). The 14,29% of them achieved PR, 57,14% SD, 71,43% DC and 28,57%PD resulting in 7,35m mPFS (95%CI 2,06- 32,52), 29,20m mOS (95%CI 18,98- ) and 11,13m m2LS (95%CI 6,66- ). Conclusions: Re-challenge therapy with pemetrexed is the most effective solution. Limitation of the study is the heterogeneity ot treatment groups.