Extended pleurectomy/decortication combined with platinum and pemetrexed chemotherapy was associated with worse outcomes in patients with resectable mesothelioma compared with chemotherapy alone, according to a randomized trial.
“As a surgeon, you have no idea how much it pains me to conclude that extended pleurectomy/decortication — an operation that we have been offering for over 70 years — has been associated with a higher risk of death, more serious complications, poorer quality of life, and higher costs, compared with mesothelioma patients who were randomized to chemotherapy alone,” said Eric Lim, MD, a thoracic surgeon at the Royal Brompton Hospital in London, during the World Conference on Lung Cancer Presidential Symposium on Monday.
The MARS2 trial included more than 300 patients and found that at a median follow-up of 22.4 months, those randomized to receive surgery and chemotherapy had an overall survival (OS) of 19.3 months, while those randomized to chemotherapy alone had a median OS of 24.8 months.
Lim presented hazard ratios for OS in two phases because the curves for the two groups overlapped, with surgery increasing the risk of death in the first 42 months after randomization by 28% (HR 1.28, 95% CI 1.02-1.60, P=0.03). The HR for the second part of the curve (42-plus months after randomization) showed no significant difference in OS between the two groups (HR 0.48, 95% CI 0.18-1.29, P=0.15).
“I would emphasize that we wouldn’t pay too much attention to the second part of the curve — where the curves overlap — because there were 15 participants in each arm at this stage,” Lim said.
“In order to improve survival in early-stage mesothelioma, stopping surgery would increase survival by 28%,” he said. “If we were to take things one step further and relinquish the entire concept of resectability in mesothelioma, we would be able to open access to effective systemic treatments currently licensed for unresectable disease.”
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