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Mesothelioma Subtype Shows Lengthier Projected Longevity: IASLC

By Charles Bankhead, Staff Writer, MedPage Today - September 21, 2007

SEOUL, Sept. 21 -- Some malignant mesothelioma patients may have a prognosis that's not as grim as once widely believed, said a Nordic collaborative group.

Patients diagnosed with epithelial subtype mesothelioma and treated solely with chemotherapy had a median survival of 15 months, while some patients survived beyond three years. This was reported at the International Association for the Study of Lung Cancer meeting by Gunnar Hillerdal, M.D., of the Karolinska University Hospital in Stockholm and colleagues.

The Nordic group experience contrasts with a clinical perception that mesothelioma patients usually die within a year, the investigators noted. A large multicenter trial based in the U.S. demonstrated a 12 month survival rate when using cisplatin with or without pemetrexed versus nine months with cisplatin alone. Other trials have yielded similar results.

Dr. Hillerdal said, "The Nordic Mesothelioma Group experience is different."

Surgery is used sparingly in treating mesothelioma in the Nordic countries. Dr. Hillerdal said, elsewhere in the world, patients with the most favorable characteristics (such as good performance status and lower-stage disease) often are recommended for surgery, leaving patients with the worst prognosis for chemotherapy treatment.

Data on 147 mesothelioma patients treated with chemotherapy alone and followed until death or for a minimum of 18 months were analyzed by Nordic investigators. All the patients were given gemcitabine, carboplatin, and liposomal doxorubicin.

In analyzing survival by histologic subtype it was seen that the epithelial subtype represented 108 patients (73%), 21 patients (14%) for the mixed subtype, and 18 patients (12%) for the sarcomatous subtype.

44% of epithelial subtype mesothelioma patients survived at least 18 months, 25% survived for two years, 9% lived three years or longer, and two patients remained alive after five years of follow-up. Those diagnosed with epithelial stage IV disease (distant metastases) had a median survival rate of 11 months, two lived for at least two years, and one patient was still living at 61 months.

Dr. Hillerdal remarked, "This is more favorable than stage IV non-small-cell lung cancer".

Patients with mixed subtype mesothelioma or sarcomatous disease had a less favorable outlook. This was demonstrated in a median survival rate of eight months and four months, respectively. There were no patients in either group that lived as long as two years.

"The key message from this study is that the survival rate for people diagnosed with mesothelioma is not as bad as many would believe," said Dr. Hillerdal. "Survival with chemotherapy can be just as good as with surgery or even better with proper patient selection. Patient selection is the important thing to consider. Stage is less important than subtype, and that should be kept in mind when evaluating results of surgical remedies."