Department of Respiratory Medicine, Sunderland Royal Hospital, Sunderland, UK.
Clin Oncol (R Coll Radiol). 2010 Apr;22(3):231-5. doi: 10.1016/j.clon.2010.01.009.
The benefit of first-line chemotherapy in malignant pleural mesothelioma (MPM) has been established. However, this disease invariably progresses and little is known about how this disease subsequently relapses after initial treatment. Data on second-line treatment are also scarce, especially outside the context of a clinical trial. We conducted a review to observe the presentation of MPM patients when their disease progresses after initial therapy and the use of second-line therapy and its associated outcomes.
Patients were retrospectively identified from the Sunderland Royal Hospital and the Northern Centre for Cancer Care, Newcastle upon Tyne, UK. Data, including demographics, clinical presentation and treatment details at first line and beyond, together with its associated benefits, were collected. Related times to treatment failure (TTF), rates of symptom improvement and survival data were also collated.
There were 62 evaluable patients in our series. At the time of data collection, 58 patients (94%) had relapsed. At disease progression, symptoms were usually similar to those at initial presentation, but in patients with prolonged TTF (>9 months) they were more likely to relapse with clinical lymphadenopathy in the neck and axilla compared with patients with TTF < or =9 months (52% vs 13%, respectively, P<0.05). Second-line treatment was given in 45% of patients. Twenty-one patients (36%) received second-line chemotherapy outside the context of a clinical trial and most had retreatment with pemetrexed-based chemotherapy due to a prolonged TTF. In patients treated with second-line therapy outside the remit of a clinical trial, a disease control rate was achieved in nine patients (43%, 95% confidence interval 22-64), whereas improvement in symptoms were noted in 13 patients (62%, 95% confidence interval 41-83). The median TTF in this setting was 6.5 months.
Patients with a prolonged TTF after first-line treatment are more likely to relapse with neck and axillary lymphadenopathy. The use of second-line chemotherapy, including rechallenge treatment, in this disease is a viable option for a selected group of MPM patients.
一线化疗在恶性胸膜间皮瘤（MPM）中的益处已得到证实。然而，这种疾病总是会进展，对于初始治疗后疾病如何随后复发知之甚少。二线治疗的数据也很少，特别是在临床试验之外。我们进行了一项回顾性研究，以观察初始治疗后疾病进展的 MPM 患者的表现，以及二线治疗的应用及其相关结果。
从英国桑德兰皇家医院和泰恩河畔纽卡斯尔的北方癌症护理中心回顾性地确定患者。收集数据，包括人口统计学、临床表现和一线及以上治疗细节，以及相关的获益。还收集了相关的治疗失败时间（TTF）、症状改善率和生存数据。
在我们的研究中，有 62 例可评估的患者。在数据收集时，58 例（94%）患者复发。疾病进展时，症状通常与初始表现相似，但在 TTF>9 个月的患者中，与 TTF≤9 个月的患者相比，更有可能出现颈部和腋窝的临床淋巴结病复发（分别为 52%和 13%，P<0.05）。45%的患者接受了二线治疗。21 例（36%）患者在临床试验之外接受了二线化疗，大多数患者因 TTF 延长而接受培美曲塞为基础的化疗再治疗。在临床试验范围之外接受二线治疗的患者中，有 9 例（43%，95%置信区间 22-64）达到疾病控制率，13 例（62%，95%置信区间 41-83）患者的症状改善。在这种情况下，TTF 的中位数为 6.5 个月。
一线治疗后 TTF 延长的患者更有可能出现颈部和腋窝淋巴结病复发。在选定的 MPM 患者群体中，二线化疗包括再挑战治疗，是一种可行的选择。
