Response to chemotherapy is predictive in relation to longer overall survival in an individual patient combined-analysis with pleural mesothelioma.
BACKGROUND
There is currently no early predictive marker of survival for patients receiving chemotherapy for malignant pleural mesothelioma (MPM). Tumour response may be predictive for overall survival (OS), though this has not been explored. We have thus undertaken a combined-analysis of OS, from a 42day landmark, of 526 patients receiving systemic therapy for MPM. We also validate published progression-free survival rates (PFSRs) and a progression-free survival (PFS) prognostic-index model.


METHODS
Analyses included nine MPM clinical trials incorporating six European Organisation for Research and Treatment of Cancer (EORTC) studies. Analysis of OS from landmark (from day 42 post-treatment) was considered regarding tumour response. PFSR analysis data included six non-EORTC MPM clinical trials. Prognostic index validation was performed on one non-EORTC data-set, with available survival data.


RESULTS
Median OS, from landmark, of patients with partial response (PR) was 12·8months, stable disease (SD), 9·4months and progressive disease (PD), 3·4months. Both PR and SD were associated with longer OS from landmark compared with disease progression (both p<0·0001). PFSRs for platinum-based combination therapies were consistent with published significant clinical activity ranges. Effective separation between PFS and OS curves provided a validation of the EORTC prognostic model, based on histology, stage and performance status.


CONCLUSIONS
Response to chemotherapy is associated with significantly longer OS from landmark in patients with MPM.
Centre for Cancer Research and Cell Biology, Queen's University Belfast, Northern Ireland, UK.
Jaine K
JK
Blayney
Giovanni L
GL
Ceresoli
Bruno
B
Castagneto
Mary E R
ME
O'Brien
Baktiar
B
Hasan
Richard
R
Sylvester
Robin
R
Rudd
Jeremy
J
Steele
Sara
S
Busacca
Camillo
C
Porta
Luciano
L
Mutti
Kenneth J
KJ
O'Byrne
Paula
P
Scullin
Rabab
R
Gaafar
Paul
P
Baas
Jan
J
Van Meerbeeck
Dean A
DA
Fennell
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome