Extended pleurectomy decortication combined with chemotherapy was associated with worse survival outcomes, a higher incidence of serious adverse events, and a diminished quality of life in patients with resectable mesothelioma compared with platinum and pemetrexed chemotherapy alone, according to new findings presented by Lim et al at the International Association for the Study of Lung Cancer (IASLC) 2023 World Conference on Lung Cancer (Abstract PL03.10).
Background
Mesothelioma, a rare and aggressive cancer primarily linked with asbestos exposure, has prompted exploration into various treatment options—including pleurectomy decortication. However, despite its common use, the effectiveness of this intervention has never been evaluated in a randomized trial.
Study Methods and Results
In the MARS 2 trial, researchers randomly assigned 335 patients with resectable mesothelioma to undergo either extended pleurectomy decortication combined with chemotherapy (n = 169) or chemotherapy alone with platinum-based therapy or pemetrexed (n = 166).
After a median follow-up of 22.4 months, the researchers found that the patients who had received extended pleurectomy decortication plus chemotherapy exhibited a median survival of 19.3 months vs 24.8 months among those who had received chemotherapy alone. However, the researchers reported that the hazards for death were nonproportional, prompting the presentation of primary outcomes in two timeframes: randomization to 42 months and beyond 42 months. The analysis indicated that the patients in the combination treatment group had a 28% increase in the risk of mortality within the first 42 months, whereas no statistically significant differences in survival emerged after 42 months.
Moreover, the researchers unveiled significant disparities in progression-free survival and adverse events between the two groups. The patients in the combination treatment group experienced a 3.6-fold higher incidence of serious adverse events—Common Terminology Criteria for Adverse Events grade 3 and above—and worse positive symptoms scores, including pain, dyspnea, insomnia, loss of appetite, and financial difficulties. The patients who underwent extended pleurectomy decortication also had a poorer quality of life and well-being on various European Organisation for Research and Treatment of Cancer health-related quality of life scales—particularly in global health, physical functioning, social functioning, and role functioning.
Conclusions
The researchers concluded that extended pleurectomy decortication should not be offered to patients with pleural mesothelioma. They underscored that classifying this disease as “unresectable” from the outset would increase access to more effective systemic treatments and improve survival in patients with early-stage disease.
