Treatment Patterns and Outcomes of Patients With Advanced Pleural Mesothelioma at an Academic Referral Centre

Our analysis suggests prolonged survival with systemic treatment overall but also specifically in elderly patients and patients with poor PS, who are generally under-represented in clinical trials. In addition, our analysis underscores the feasibility of high investigational trial recruitment within a dedicated mesothelioma clinic at a large academic referral center. Background: Overall survival (OS) for malignant pleural mesothelioma (MPM) in vulnerable subgroups remains poorly understood with scarce data available to guide treatment decisions. The study describes real-world detailed treatment patterns and outcomes of patients with advanced MPM overall and specifically in elderly and poor performance status (PS) patients. Methods: Retrospective chart review was performed for all patients with histologically confirmed MPM seen at University Health Networ k/Pr incess Margaret Cancer Centre (UHN-PM). Results: A total of 667 patients with MPM were identified and 304 advanced-disease MPM (aMPM) patients had continuing care at U HN- P M (UP-cohort). In the UP-cohort, 77% of patients received >= one line of systemic treatment. Systemic therapy trial participation was 39%. Patients not treated with systemic therapy (29%) were more likely to be >= 75 years and PS >= 2. Median OS was 15.3 months (95%CI 13.6-18.3), with longer survival in treated vs. untreated patients (17.4 vs. 10.6 months; P = .01). Longer survival with systemic treatment was seen in patients >= 75 years (12.7 vs. 6.6 months) and patients with poor PS (9.1 vs. 5.9 months). Median progression-free-survival (PFS) and OS for patients treated with second-line therapy was poor (3.0 and 8.9 months, respectively). Discussion: In our real-world analysis of patients with aMPM treated at an academic referral centre, systemic treatment was given to the majority of patients and benefit was seen even in the elderly and poor PS patients frequently underrepresented in clinical tr ials. Tr ial participation was potentially facilitated by the formation of a dedicated multidisciplinary MPM clinic.

Automated summary

Our analysis reveals that systemic treatment can improve overall survival for advanced MPM patients, including elderly and poor PS patients who are usually underrepresented in clinical trials. Furthermore, the study highlights the successful recruitment of patients for investigational trials in a specialized mesothelioma clinic.