Comparison of Survival by Multimodal Treatment Regimen Among Malignant Pleural Mesothelioma Patients in an Integrated Health System

Kian C Banks; Stephanie Ossowski; Yun-Yi Hung; Diana S Hsu; Simon K Ashiku; Ashish R Patel; Jeffrey B Velotta; J Marie Suga

doi:10.1016/j.cllc.2022.09.003

Comparison of Survival by Multimodal Treatment Regimen Among Malignant Pleural Mesothelioma Patients in an Integrated Health System

Clin Lung Cancer. 2022 Dec;23(8):694-701. doi: 10.1016/j.cllc.2022.09.003. Epub 2022 Sep 17.

Authors

Kian C Banks¹, Stephanie Ossowski², Yun-Yi Hung³, Diana S Hsu⁴, Simon K Ashiku⁵, Ashish R Patel⁵, Jeffrey B Velotta⁵, J Marie Suga⁶

Affiliations

¹ Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA; University of California, San Francisco - East Bay, Oakland, CA. Electronic address: kian.banks@ucsf.edu.
² Department of Hematology/Oncology, Kaiser San Francisco Medical Center, San Francisco, CA.
³ Division of Research, Kaiser Permanente Northern California, Oakland, CA.
⁴ Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA; University of California, San Francisco - East Bay, Oakland, CA.
⁵ Department of Thoracic Surgery, Kaiser Oakland Medical Center, Oakland, CA.
⁶ Department of Oncology, Kaiser Vallejo Medical Center, Vallejo, CA.

PMID: 36216742
DOI: 10.1016/j.cllc.2022.09.003

Abstract

Background: Optimal therapy for malignant pleural mesothelioma (MPM) remains unclear. We compared overall survival in patients with MPM after various multimodal treatment regimens including combinations of immunotherapy, chemotherapy, and surgery.

Patients and methods: We examined MPM patients treated within our integrated health system from January 1, 2009 to December 31, 2020. Patients were grouped based on treatment regimen: chemotherapy alone (CT), immunotherapy with or without chemotherapy (iCT), surgery with chemotherapy (sCT), and surgery with immunotherapy and chemotherapy (siCT). We analyzed baseline characteristics and overall patient survival among these groups and several subgroups.

Results: One hundred seventy-nine patients were included. Among the study groups, there was no difference in age, sex, race/ethnicity, Charlson Comorbidity Index, or Eastern Cooperative Oncology Group performance status. Patients treated with CT (N = 109), iCT (N = 35), sCT (N = 26), and siCT (N = 9) had median (95% confidence interval) survivals of 11.7 (9.9-16.3), 18.2 (14.5-29.8), 20.7 (11.6-37.2), and 22.6 (19.7-37.8) months, respectively (P < .001). Median survival among patients with and without immunotherapy was 19.7 (17.4-29.8) and 12.3 (10.6-17.3) months, respectively (P = .023). Median survival among patients with and without surgery was 21.7 (17.6-34.8) and 13.6 (11.5-17.3) months, respectively (P = .007). Patients with biphasic/sarcomatoid subtypes who received immunotherapy experienced 76.2% (55.8%-100.0%) 12 month survival vs. 13.6% (4.8%-39.0%) among those who did not (P < .001).

Conclusion: MPM patients receiving surgery and immunotherapy as part of multimodal treatment regimens experienced the longest survival. Surgery and immunotherapy are each associated with survival. Further investigations are warranted to assess the benefit of immunotherapy within multimodal treatment regimens for MPM.

Keywords: Cancer; Immunotherapy; Outcomes; Surgery; Therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Combined Modality Therapy
Delivery of Health Care, Integrated*
Humans
Lung Neoplasms* / drug therapy
Mesothelioma*
Mesothelioma, Malignant*
Pleural Neoplasms* / pathology