Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP)

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population.

Methods: The MeSO-CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first-line chemotherapy among Latin American patients.

Results: The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first-line platinum-based chemotherapy. The overall response rate to first-line chemotherapy was 40.4%, progression-free survival to first-line treatment was 5.7 months (95% CI 4.9-6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0-20.5), and multivariate analysis found that stage (P = 0.013), and pleurodesis (P = 0.048), were independent prognostic factors for first-line overall survival. The model to predict response to first-line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non-responders.

Conclusion: This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.

Keywords: Asbestos exposure; Latin America; chemotherapy; mesothelioma.

Figure 1

(a) Progression‐free survival (PFS) to first‐line (FL) therapy. (b) PFS to FL therapy according to histology. Histology, Epithelioid () 6.7 months (CI 95% 4.9–8.5), Sarcomatoid () 3.5 months (CI 95% 2.1–4.9) and Mixed () 3.8 months (CI 95% 3.3–4.4). (c) Overall survival (OS) to FL therapy. (d) OS to FL therapy according to histology. Histology, Epithelioid () 20.7 months (CI 95% 14.78–26.6), Sarcomatoid () 13.4 months (CI 95% 10.1–16.6) and Mixed () 14.7 months (CI 95% 9.7–19.6).

Figure 2

(a) Median progression‐free survival (PFS) to second‐line (SL) therapy. (b) The median overall survival (OS) to SL therapy was 14.6 months (95% CI 11.4–17.8).