Author of

• 20144

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  MA 19 - Mesothelioma: Bench to Bedside (ID 680)

  • Event: WCLC 2017
  • Type: Mini Oral
  • Track: Mesothelioma
  • Presentations: 1
  • Moderators:Dean A Fennell, Hedy Lee Kindler
  • Coordinates: 10/18/2017, 11:00 - 12:30, Room 315

  • 24303

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    MA 19.09 - The Role of Neoadjuvant Chemotherapy in Patients with Malignant Pleural Mesothelioma (ID 10187)

    12:00 - 12:05  |  Author(s): P.J. Speicher
    • Abstract
    • Presentation
    • Slides

    Background:
    The treatment of localized malignant pleural mesothelioma (MPM) involves multimodality therapy, however, there is no standard of care with respect to operative procedure and timing of chemotherapy. We analyzed data from a single institution to identify whether the use of pemetrexed-platinum neoadjuvant chemotherapy impacts survival.
    
    Method:
    Patients with histologically-proven MPM who had surgery from 1996 to 2016 were identified. Follow-up was complete for a median of 24 months. Survival was calculated from time of diagnosis to last follow up or death. Univariate and multivariate Cox proportional hazards were used.
    
    Result:
    From 1996 to 2016 we identified 376 patients. Mean age was 66+/-8 years and 54 (14%) were female. There was no difference in survival for pleurectomy/decortication or extrapleural pneumonectomy. Neoadjuvant chemotherapy significantly improved survival compared to surgery followed by chemotherapy (table 1). Multivariate analysis was significantly associated for increased survival for epithelioid histology, T-status, node positivity, and neoadjuvant chemotherapy (table 2).

    Table 1. Univariate Analysis

    Variable	(n)	Median survival (mo.)	P value
    Gender	Male (322) Female (54)	13.6 17.2	P=0.043
    Histology	Epithelial (252) Mixed (91) Sarcomatoid (26)	18.3 12.1 6.5	P<0.0001
    T stage	T 1-2 (33) T 3-4 (343)	42.6 14.3	P=0.0002
    N status	N 0 (129) N 1-2 (113)	23.1 11.3	P<0.0001
    Neoadjuvant chemotherapy	Yes (153) No (223)	19.8 11.3	P<0.0001

    Table 2. Cox Proportional Hazards Model

    Covariate	Hazard Ratio	95% CI	p-value
    Histology (ref: Epithelioid) Biphasic Sarcomatoid	ref 1.66 4.24	[ref] [1.17-2.36] [1.77-10.1]	ref 0.005 0.001
    T-status 3-4 vs 1-2	3.07	[1.32-7.15]	0.009
    Node-positivity	1.93	[1.40-2.66]	<0.001
    Neoadjuvant chemotherapy	0.65	[0.47-0.91]	0.011

    Cox proportional hazards model including histology, t-status, n-status, and neoadjuvant chemotherapy C-index: 0.69
    
    Conclusion:
    Our results suggest that neoadjuvant chemotherapy increases survival and likely enhances the complete resection rate. These data are being evaluated in a multi-institutional cohort of five major mesothelioma programs in North America to improve guidelines for mesothelioma therapy.
    
    

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