For mesothelioma patients, the addition of chemotherapy to the usual active symptom control (ASC) does not appear to improve survival or quality of life, according to an article released on May 16, 2008 in The Lancet.
Malignant pleural mesothelioma (MPM) is cancer of the mesothelium, the protective layer that covers the lungs. Generally associated with exposure to asbestos, it is almost always fatal.
Worldwide, this cancer has been rising. For example, in the UK, the mortality rate increased by a factor of 12 between 1968 and 2001, and nearly 2000 deaths were recorded in 2005. By 2013, the yearly death rate due to mesothelioma is expected to increase to 2200. Similar death rates are found in the United States and in Western Europe. Due to the risks of asbestos exposure, however, the epidemic will shift towards countries that produce or use large quantities of asbestos, such as Russia, China, Canada, Kazakhstan, Brazil, Zimbabew, India, and Thailand.
To investigate various treatment options for MPM patients, Richard Stephens and Professor Mahesh Parmar, Medical Research Council (MRC) Clinical Trials Unit, London, UK, and colleagues performed the MS01 study, funded by Cancer Research UK. This randomized trial examined 409 patients with MPM from 76 centers in the UK and two in Australia. OF these, 136 were randomly assigned to be administered ASC alone; 137 were given ASC plus MVP chemotherapy, which involved four cycles of 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 the treatment. Due to an insufficient number of recruited subjects, an assessment of the individual chemotherapy treatments was not possible, so the groups were combined and compared with the baseline ASC only group 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/MVP group, and 129 came from the ASC/vinorelbine group. A small benefit to the 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 not statistically significant. Analysis of the quality of life in each of the groups, including physical functioning, pain, shortness of breath, and overall health status, were similar.
The authors conclude that this particular therapy method does not improve the fate of the mesothelioma patient: “The addition of chemotherapy to ASC offers no significant benefits in terms of overall survival or quality of life. However, exploratory analyses suggested that vinorelbine merits further investigation.”
Dr Nicholas J Vogelzang, Nevada Cancer Institute, Las Vegas, NV, USA, contributed an accompanying comment in which he discusses evidence regarding various chemotherapy regimens for this disease. “Patients with MPM who wish to be treated should be informed that strong medical evidence establishes the standard of care for MPM as cisplatin and pretrexed. Although cisplatin plus gemcitabine might be equally effective, there have as yet been no randomised comparisons of the two doublet regimens.”
Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (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 J Girling, Matthew Nankivell, Cheryl Pugh, Mahesh K B Parmar, on behalf of the MS01 Trial Management Group
Lancet 2008; 371: 1685-94
Chemotherapy for malignant pleural mesothelioma
Nicholas J Vogelzang
Lancet 2008; 371: 1640-2
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Written by Anna Sophia McKenney