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. 2022 Sep;5(9):e1568.
doi: 10.1002/cnr2.1568. Epub 2021 Oct 26.

Treatment patterns and outcomes in older patients with advanced malignant pleural mesothelioma: Analyses of Surveillance, Epidemiology, and End Results-Medicare data

Mark D Danese  1 , Melinda Daumont  2 , Esmond Nwokeji  2 , Michelle Gleeson  1 , John R Penrod  2 , Deborah Lubeck  1
Affiliations

Treatment patterns and outcomes in older patients with advanced malignant pleural mesothelioma: Analyses of Surveillance, Epidemiology, and End Results-Medicare data

Mark D Danese et al. Cancer Rep (Hoboken). 2022 Sep.

Abstract

Background: Malignant mesothelioma is a rare neoplasm associated with asbestos exposure. Characterizing treatment patterns and outcomes of older patients with advanced malignant pleural mesothelioma (MPM) is important to understand the unmet needs of this population.

Aim: To evaluate the demographic and clinical characteristics, treatment patterns, and outcomes among older patients diagnosed with advanced MPM in the United States between 2007 and 2013.

Methods: This was a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims. We included patients who were age 66 or older at the time of their primary MPM diagnosis between 2007 and 2013 and followed them through 2014. Treated patients who received first-line chemotherapy with pemetrexed and platinum within 90 days of diagnosis, second-line, or third-line therapy were identified for evaluation of outcomes.

Results: There were 666 older patients with advanced MPM, of whom 82% were male, 87% White, 78% stage IV, and 70% had no mobility limitation indicators at diagnosis. There were 262 patients who received first-line chemotherapy for advanced MPM, most of whom (80%; n = 209) received pemetrexed-platinum. Of these 209 patients, 41% (n = 86) initiated second-line therapy, and 26% (n = 22) initiated third-line therapy. Median overall survival for the cohort of 209 patients was 7.2 months. Patients with epithelioid histology had better median overall survival (12.2 months) compared with other histologies (4.4-5.6 months). Within 90 days of diagnosis of advanced MPM, 78% of patients were hospitalized, 52% visited an emergency department, and 21% had hospice care. The 2-year cost of care was over $100 000 for all patients with advanced MPM treated with first-line pemetrexed-platinum.

Conclusions: Although first-line systemic anticancer treatment was generally consistent with guidelines (e.g., pemetrexed-platinum), poor patient outcomes highlight the need for effective treatment options for older patients with advanced MPM.

Keywords: Epidemiology; Surveillance; and End Results; costs; mesothelioma; overall survival; treatment.

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Conflict of interest statement

Mark D. Danese, Michelle Gleeson, and Deborah Lubeck are employees of Outcomes Insights, Inc, which was funded by Bristol‐Myers Squibb for performing the analysis reported in this manuscript. Melinda Daumond and John R. Penrod are employees of Bristol‐Myers Squibb. Esmond Nwokeji was a BMS contractor at the time this research was conducted.

Figures

FIGURE 1
FIGURE 1
Cohort selection. Patients included in the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked databases meeting the criteria for inclusion, and treatment patterns among patients included in the study. MPM, malignant pleural mesothelioma
FIGURE 2
FIGURE 2
Unadjusted overall survival in study cohorts. (A) All patients with advanced malignant pleural mesothelioma (MPM) (advanced MPM cohort); (B) patients with advanced MPM who received first‐line pemetrexed‐platinum (first‐line pemetrexed‐platinum cohort); (C) subgroup of the first‐line pemetrexed‐platinum cohort who received second‐line therapy (second‐line cohort); and (D) subgroup of the second‐line cohort who received third‐line therapy (third‐line cohort). NOS; not otherwise specified
See this image and copyright information in PMC

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