恶性胸膜间皮瘤患者的系统治疗——真实的临床经验。

Systemic treatment in patients with malignant pleural mesothelioma - real life experience.

机构信息

Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.

Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland.

出版信息

BMC Cancer. 2022 Apr 20;22(1):432. doi: 10.1186/s12885-022-09490-8.

DOI:10.1186/s12885-022-09490-8

PMID:35443624

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9022247/

Abstract

BACKGROUND

Malignant pleural mesothelioma (MPM) is a rare, aggressive malignancy of the pleural cavity linked to asbestos exposure. The combination of pemetrexed and platinum is a standard first-line therapy for malignant pleural mesothelioma. Despite some progress, almost all MPM patients experience progression after first-line therapy. The second-line treatment is still being under discussion and there are very limited data available on the second-line and subsequent treatments.

METHODS

The retrospective analysis included 57 patients (16 females and 41 males) from two Polish oncological institutions treated for advanced mesothelioma between 2013 and 2019. We analysed the efficacy of first-line and second-line therapy: progression-free survival (PFS), overall survival (OS), overall response rate (ORR).

RESULTS

In the first-line treatment, 55 patients received pemetrexed-based chemotherapy (PBC) and two cisplatin in monotherapy. Patients' characteristics at baseline: median age was 64.2 years, ECOG PS ≤ 1 (86.2%), epithelial histology (85.7%). Median PFS and OS were 7.6 months and 14 months, respectively. Patients with ECOG PS ≤ 1 vs > 1 had a longer median OS (14.8 months vs 9.7 months, p = 0.057). One-year OS and PFS were 60.9% and 32.0%, respectively. Disease control rate (DCR) was 82.5%. Response to first-line therapy: PFS ≥ 6 months and PFS ≥ 12 months had a significant impact on median OS. Twelve patients received second-line therapy (seven PBC and five other cytotoxic single agents: navelbine, gemcitabine, or adriamycin/vincristine/methotrexate triplet). Median PFS and OS were 3.7 months and 7.2 months, respectively. DCR was 83%. One-year OS and PFS were 37% and 16.7%, respectively. In the group receiving PBC, OS was prolonged by 4.5 months compared to the non-PBC group (6.0 months vs 10.5 months, p = 0.47).

CONCLUSION

Patients who benefited from first-line therapy and had prolonged PFS at first-line and achieve PFS longer than 6 months at first-line should be offered second-line treatment. Consideration of retreatment with the same cytotoxic agent could to be a viable option when no other treatment are available.

摘要

背景

恶性胸膜间皮瘤（MPM）是一种罕见的、侵袭性的胸膜腔恶性肿瘤，与石棉暴露有关。培美曲塞联合铂类药物是治疗恶性胸膜间皮瘤的标准一线治疗方法。尽管取得了一些进展，但几乎所有 MPM 患者在一线治疗后都会出现进展。二线治疗仍在讨论中，关于二线和后续治疗的可用数据非常有限。

方法

这项回顾性分析纳入了 2013 年至 2019 年期间在波兰两家肿瘤学机构接受晚期间皮瘤治疗的 57 名患者（16 名女性和 41 名男性）。我们分析了一线和二线治疗的疗效：无进展生存期（PFS）、总生存期（OS）、总缓解率（ORR）。

结果

在一线治疗中，55 名患者接受培美曲塞为基础的化疗（PBC）联合铂类药物，2 名患者接受顺铂单药治疗。患者基线特征：中位年龄为 64.2 岁，ECOG PS≤1（86.2%），上皮组织学（85.7%）。中位 PFS 和 OS 分别为 7.6 个月和 14 个月。ECOG PS≤1 与>1 的患者 OS 中位数更长（14.8 个月与 9.7 个月，p=0.057）。1 年 OS 和 PFS 分别为 60.9%和 32.0%。疾病控制率（DCR）为 82.5%。一线治疗的反应：PFS≥6 个月和 PFS≥12 个月对 OS 有显著影响。12 名患者接受二线治疗（7 名接受 PBC，5 名接受其他细胞毒性单药治疗：长春瑞滨、吉西他滨或阿霉素/长春新碱/甲氨蝶呤三联化疗）。中位 PFS 和 OS 分别为 3.7 个月和 7.2 个月。DCR 为 83%。1 年 OS 和 PFS 分别为 37%和 16.7%。在接受 PBC 治疗的患者中，与非 PBC 组相比，OS 延长了 4.5 个月（6.0 个月比 10.5 个月，p=0.47）。