Chemotherapy Does Not Improve Treatment For Mesothelioma
May 16th, 2008 | by admin |For mesothelioma patients, the addition of chemotherapy to the usualactive symptom control (ASC) does not appear to improve survival orquality of life, according to an article released on May 16, 2008 in TheLancet.
Malignant pleural mesothelioma (MPM) is cancer of the mesothelium, theprotective layer that covers the lungs. Generally associated withexposure to asbestos, it is almost always fatal.
Worldwide, this cancer has been rising. For example, in the UK, themortality rate increased by a factor of 12 between 1968 and 2001, andnearly 2000 deaths were recorded in 2007. By 2013, the yearly deathrate due to mesothelioma is expected to increase to 2200. Similar deathrates are found in the United States and in Western Europe. Due to therisks of asbestos exposure, however, the epidemic will shift towardscountries that produce or use large quantities of asbestos, such asRussia, China, Canada, Kazakhstan, Brazil, Zimbabew, India, andThailand.
To investigate various treatment options for MPM patients, RichardStephens and Professor Mahesh Parmar, Medical Research Council (MRC)Clinical Trials Unit, London, UK, and colleagues performed the MS01study, funded by Cancer Research UK. This randomized trial examined 409patients with MPM from 76 centers in the UK and two in Australia. OFthese, 136 were randomly assigned to be administered ASC alone; 137were given ASC plus MVP chemotherapy, which involved four cyclesof mitomycin, vinblastine, and cisplatin every three weeks;the remaining 136 patients received ASC plus vinorelbine chemotherapy,which was one injection of vinorelbine every week for twelve weeks.Follow up was performed every three weeks up to 21 weeks after thetreatment. Due to an insufficient number of recruited subjects, anassessment of the individual chemotherapy treatments was not possible,so the groups were combined and compared with the baseline ASC onlygroup for the primary outcome of overall survival.
When the analysis was performed, 393 (96%) of the patients had died.132 of these came from the ASC only group, 132 came from the ASC/MVPgroup, and 129 came from the ASC/vinorelbine group. A small benefit tothe combination therapy was present but not statistically significant.Patients in the ASC/vinorelbine group also showed improved survival,with a larger number alive after one year, but this was also notstatistically significant. Analysis of the quality of life in each ofthe groups, including physical functioning, pain, shortness of breath,and overall health status, were similar.
The authors conclude that this particular therapy method does notimprove the fate of the mesothelioma patient: “The addition ofchemotherapy to ASC offers no significant benefits in terms of overallsurvival or quality of life. However, exploratory analyses suggestedthat vinorelbine merits further investigation.”
Dr Nicholas J Vogelzang, Nevada Cancer Institute, Las Vegas, NV, USA,contributed an accompanying comment in which he discusses evidenceregarding various chemotherapy regimens for this disease. “Patientswith MPM who wish to be treated should be informed that strong medicalevidence establishes the standard of care for MPM as cisplatin andpretrexed. Although cisplatin plus gemcitabine might be equallyeffective, there have as yet been no randomised comparisons of the twodoublet regimens.”
Active symptom control with or without chemotherapy in thetreatment of patients with malignant pleuralmesothelioma (MS01): a multicentre randomised trial
Martin F Muers, Richard J Stephens, Patricia Fisher, Liz Darlison,Christopher M B Higgs, Erica Lowry, Andrew G Nicholson, Mary O’Brien,Michael Peake, Robin Rudd, Michael Snee, Jeremy Steele, David JGirling, Matthew Nankivell, Cheryl Pugh, Mahesh K B Parmar, on behalfof the MS01 Trial Management Group
Lancet 2008; 371: 1685-94
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Chemotherapy for malignant pleural mesothelioma
Nicholas J Vogelzang
Lancet 2008; 371: 1640-2
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Written by Anna Sophia McKenney
Copyright: Medical News Today
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