Arrieta Oscar, Muñoz-Montaño Wendy, Muñiz-Hernández Sae, Campos Saul, Catalán Rodrigo, Soto-Molina Herman, Guzmán Vázquez Silvia, Díaz-Álvarez Osvaldo, Martínez-Pacheco Victor, Turcott Jenny G, Ramos-Ramírez Maritza, Cabrera-Miranda Luis, Barrón Feliciano, Cardona Andrés F
Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico.
Thoracic Oncology Unit, Instituto Nacional de Cancerologia, Mexico City, Mexico.
Front Oncol. 2021 Apr 20;11:641975. doi: 10.3389/fonc.2021.641975. eCollection 2021.
Malignant pleural mesothelioma (MPM) is rare and aggressive neoplasia, with a poor prognosis; furthermore, the monetary cost of its treatment represents a major challenge for many patients. The economic burden this malignancy imposes is underscored by the fact that asbestos exposure, which is the most frequent risk factor, is much more prevalent in the lower socioeconomic population of developing countries. The aims of the present study were to evaluate the efficacy, safety, and cost of continuous infusion of low-dose Gemcitabine plus Cisplatin (CIGC) as a treatment strategy for patients with unresectable MPM.
We performed a prospective cohort study to determine efficacy and safety of continuous infusion gemcitabine at a dose of 250 mg/m2 in a 6-h continuous infusion plus cisplatin 35 mg/m2 on days 1 and 8 of a 21-day cycle in patients with unresectable MPM. We also performed a cost-minimization analysis to determine if this chemotherapy regimen is less expensive than other currently used regimens.
The median number of chemotherapy cycles was six (range 1-11 cycles); objective response rate was documented in 46.2%, and disease control rate was seen in 81.2%. Median PFS was 8.05 months (CI 95% 6.97-9.13); median OS was 16.16 months (CI 95% 12.5-19.9). The cost minimization analysis revealed savings of 66.4, 61.9, and 97.7% comparing CIGC with short-infusion gemcitabine plus cisplatin (SIGC), cisplatin plus pemetrexed (CP), and cisplatin plus pemetrexed and bevacizumab (CPB), respectively. Furthermore, this chemotherapy regimen proved to be safe at the administered dosage.
CIGC is an effective and safe treatment option for patients with unresectable MPM; besides, this combination is a cost-saving option when compared with other frequently used chemotherapy schemes. Therefore, this treatment scheme should be strongly considered for patients with unresectable MPM and limited economic resources.
恶性胸膜间皮瘤（MPM）是一种罕见且侵袭性强的肿瘤，预后较差；此外，其治疗费用对许多患者来说是一项重大挑战。这种恶性肿瘤带来的经济负担因以下事实而凸显：作为最常见风险因素的石棉暴露，在发展中国家社会经济地位较低的人群中更为普遍。本研究的目的是评估持续输注低剂量吉西他滨加顺铂（CIGC）作为不可切除MPM患者治疗策略的疗效、安全性和成本。
我们进行了一项前瞻性队列研究，以确定在不可切除MPM患者中，在21天周期的第1天和第8天，以250mg/m²的剂量持续输注6小时吉西他滨加35mg/m²顺铂的疗效和安全性。我们还进行了成本最小化分析，以确定该化疗方案是否比其他目前使用的方案成本更低。
化疗周期的中位数为6个（范围1 - 11个周期）；客观缓解率为46.2%，疾病控制率为81.2%。中位无进展生存期为8.05个月（95%置信区间6.97 - 9.13）；中位总生存期为16.16个月（95%置信区间12.5 - 19.9）。成本最小化分析显示，与短程输注吉西他滨加顺铂（SIGC）、顺铂加培美曲塞（CP）和顺铂加培美曲塞及贝伐单抗（CPB）相比，CIGC分别节省了66.4%、61.9%和97.7%。此外，该化疗方案在给药剂量下被证明是安全的。
CIGC是不可切除MPM患者的一种有效且安全的治疗选择；此外，与其他常用化疗方案相比，这种联合用药是一种节省成本的选择。因此，对于不可切除且经济资源有限的MPM患者，应强烈考虑这种治疗方案。
