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Malignant Pleural Mesothelioma Outcomes in the Era of Combined Platinum and Folate Antimetabolite Chemotherapy


Affiliations
1 Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
2 The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, K1Y 4E9, Canada
 

Introduction: Malignant pleuralmesothelioma (MPM) is associated with a poor prognosis. Palliative platinum-based chemotherapy may help to improve symptoms and prolong life. Since 2004, the platinum is commonly partnered with a folate antimetabolite. We performed a review investigating if survival had significantly changed before and after the arrival of folate antimetabolites in clinical practice. Methods: All MPM patients from January 1991 to June 2012 were identified. Data collected included age, gender, asbestos exposure, presenting signs/symptoms, performance status, histology, stage, bloodwork, treatment modalities including chemotherapy, and date of death or last follow-up. The primary endpoint was overall survival. Cox models were applied to determine variables associated with survival. Results: There were 245 patients identified. Median overall survival for all patients was 9.4 months. After multivariate analysis, performance status, stage, histology, leucocytosis, and thrombophilia remained independently associated with survival. Among all patients who received chemotherapy, there was no difference in overall survival between the periods before and after folate antimetabolite approval: 14.2 versus 13.2 months (𝑃 = 0.35). Specifically receiving combined platinum-based/folate antimetabolite chemotherapy did not improve overall survival compared to all other chemotherapy regimens: 14.1 versus 13.6 months (P = 0.97). Conclusions: In this review, we did not observe an incremental improvement in overall survival after folate antimetabolites became available.
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  • Malignant Pleural Mesothelioma Outcomes in the Era of Combined Platinum and Folate Antimetabolite Chemotherapy

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Authors

Mathieu D. Saint-Pierre
Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
Christopher Pease
Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
Hamid Mithoowani
Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
Tinghua Zhang
The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, K1Y 4E9, Canada
Garth A. Nicholas
Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
Scott A. Laurie
Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
Paul Wheatley-Price
Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

Abstract


Introduction: Malignant pleuralmesothelioma (MPM) is associated with a poor prognosis. Palliative platinum-based chemotherapy may help to improve symptoms and prolong life. Since 2004, the platinum is commonly partnered with a folate antimetabolite. We performed a review investigating if survival had significantly changed before and after the arrival of folate antimetabolites in clinical practice. Methods: All MPM patients from January 1991 to June 2012 were identified. Data collected included age, gender, asbestos exposure, presenting signs/symptoms, performance status, histology, stage, bloodwork, treatment modalities including chemotherapy, and date of death or last follow-up. The primary endpoint was overall survival. Cox models were applied to determine variables associated with survival. Results: There were 245 patients identified. Median overall survival for all patients was 9.4 months. After multivariate analysis, performance status, stage, histology, leucocytosis, and thrombophilia remained independently associated with survival. Among all patients who received chemotherapy, there was no difference in overall survival between the periods before and after folate antimetabolite approval: 14.2 versus 13.2 months (𝑃 = 0.35). Specifically receiving combined platinum-based/folate antimetabolite chemotherapy did not improve overall survival compared to all other chemotherapy regimens: 14.1 versus 13.6 months (P = 0.97). Conclusions: In this review, we did not observe an incremental improvement in overall survival after folate antimetabolites became available.