BACKGROUND: There is no standard of care with respect to the use of neoadjuvant chemotherapy (NAC) in resectable malignant pleural mesothelioma (MPM). We performed an intention-to-treat analysis with data from a single institution and the National Cancer Database (NCDB) to identify whether the use of [ neoadjuvant chemotherapy (NAC) ] impacts survival in [ resectable malignant pleural mesothelioma ].
METHODS: Patients with MPM who had surgery with curative intent at Duke University from 1995-2017 were selected, and the 2004-2015 NCDB was used to identify MPM patients with clinical stage I-IIIB who underwent definitive surgery. For both cohorts, patients were stratified by receipt of neoadjuvant chemotherapy. Primary outcomes were overall survival (OS) and post-resection survival (RS), which were estimated using Kaplan-Meier and multivariable Cox Proportional Hazards models.
RESULTS: 257 patients met inclusion criteria in the Duke cohort. Compared to immediate resection (IR), [ neoadjuvant chemotherapy (NAC) ] was associated with similar OS but an increased risk for post-resection mortality in both unmatched (adjusted HR?=?1.85; 95%CI=1.21-2.83) and propensity-matched (HR 1.62; 95%CI 1.03-2.55) cohorts. A total of 1949 NCDB patients were included: 1597 (81.9%) IR and 352 (18.1%) NAC. Post-resection survival was worse for patients undergoing NAC in both unmatched (HR 1.85; 95%CI 1.21-2.83) and propensity-matched (HR 1.29; 95%CI 1.06-1.57) analyses compared to patients receiving IR.
CONCLUSION: In this intention-to-treat study, [ neoadjuvant chemotherapy (NAC) ] was associated with worse post-resection survival compared to IR in patients with MPM. The risks and benefits of induction therapy should be weighed before offering it to patients with [ resectable malignant pleural mesothelioma ].
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