New Study: EPP too Risky for Mesothelioma Patients, Pleurectomy with Chemo Better

In Belgium, two thoracic oncologists are calling for a new mesothelioma clinical trial to examine the effects of perioperative chemotherapy in conjunction with lung-sparing pleurectomy/decortication (P/D) surgery.

Pleurectomy/decortication has been the surgery of choice for treating pleural mesothelioma since 2011, when the Mesothelioma and Radical Surgery (MARS) randomized feasibility study concluded that extrapleural pheumonectomy should be abandoned as a mesothelioma treatment because the surgery is too risky to perform on seriously ill patients. Extrapleural pneumonectomy is a surgery during which not only the diseased pleura containing the mesothelioma is removed, but also the nearest lung, diaphragm, and other membranes.

Still, according to the team from Antwerp, surgery alone is not enough: most patients do better when they are administered perioperative chemotherapy to keep their mesothelioma in check. Perioperative chemotherapy is given to the patient before, during, and after surgery. In light of this fact in conjunction with the data gathered by the MARS study, a new article in the Journal of Throacic Oncology reveals that the European Organisation for research and Treatment of Cancer will begin a trial designed to specifically study the effectiveness of perioperative chemotherapy in conjunction with pleurectomy surgery.

According to the Antwerp team, “The observation that patients treated with P/D had an equal to better outcome than those treated with EPP, and that EPP with perioperative chemotherapy was better than EPP alone, raises the issue whether performing a P/D with perioperative chemotherapy would result in a further improvement of outcome with a lower operative mortality than with EPP and perioperative chemotherapy.”

Though the article does not mention which chemotherapy drugs will play a role in the new trial, recent research out of Egypt suggests that different stages of mesothelioma may be better treated with different chemotherapy regimens. In a Phase II study, researchers at the Cairo University School of Medicine noted comparable outcomes in mesothelioma patients who received a combination of pemetrexed and carboplatin and those who received the more affordable combination of gemcitabineand cisplatin when the stage of their disease was also taken into consideration.

The group given pemetrexed and carboplatin showed a 57.8% survival rate at 1.5 years, while the gemcitabine/cisplatin group showed a 41% survival rate for the same duration. Researchers say that the impact of this difference would be minimal in the advanced stages of mesothelioma, stating, “Pemetrexed plus carboplatin are a step forward in the treatment of mesothelioma, [but] the prognosis for these patients remains poor. Cheaper combinations such as gemcitabine and cisplatin may be considered sufficient to treat cases with advanced mesothelioma.”

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