Paula Antonia Ugalde, MD
Discussant of the abstract on the MARS-2 trial, Paula Antonia Ugalde, MD, Associate Surgeon, Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, underscored the significance of this “outstanding trial,” which she called a “landmark study for the field.”
Despite the ban on asbestos, she noted, the number of people diagnosed with mesothelioma continues to rise around the world. In Europe, survival has remained approximately the same for the past 50 years, “potentially due to the lack of standardization of staging and treatment.”
Trial Considerations Warrant Attention
Survival curves from the MARS-2 trial demonstrated no significant difference between the two treatment arms, said Dr. Ugalde, which indicated that extended pleurectomy decortication for mesothelioma did not show a clear advantage over chemotherapy alone in terms of survival. However, she also raised questions pertaining to the prerandomization phase of the trial.
“Chest CT scans used for disease assessment may underestimate the volume of disease and lack information on managing pleural effusion, which can impact patient selection and outcomes,” she said. “The absence of recommended imaging modalities and invasive mediastinal staging in the trial also raises concerns about the balance of tumor volume between treatment arms and the potential impact on outcomes.”
Another key concern raised by Dr. Ugalde was the lack of detailed information on surgeon experience. With 90% of patients undergoing extended pleurectomy decortication, she questioned the potential morbidity associated with diaphragmatic resection and the surgeons’ proficiency in performing the procedure. Furthermore, the relatively high 90-day mortality rate raised doubts regarding the surgical outcomes.
Finally, Dr. Ugalde highlighted the impact of center volume on outcomes. Approximately 45% of the patients in the trial came from low-volume centers, she said, which may have affected the surgical outcomes. She posed this question: “Would the outcome be different in exclusively high-volume centers?”
DISCLOSURE: Dr. Ugalde reported financial relationships with AstraZeneca and Merck Sharpe & Dohme.
