The Adem Crosby Cancer Centre, Department of Medical Oncology, Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia.
School of Medicine, The University of Queensland, Herston, Australia.
Asia Pac J Clin Oncol. 2024 Dec;20(6):723-730. doi: 10.1111/ajco.14098. Epub 2024 Jun 21.
To evaluate the real-world treatment patterns and outcomes for patients with pleural mesothelioma (PM) in the era of immunotherapy.
This retrospective audit included patients with PM diagnosed within three tertiary referral centers in Queensland, Australia from January 2017 to July 2023. Patient and treatment characteristics and outcomes were recorded. Data was analyzed using descriptive statistics and the Kaplan-Meier survival method.
A total of 90 patients were included: 84% were male, the median age was 75 years (range 70-79) and 85% had baseline Eastern Group Cooperative Group of 0-1. Subtypes included 54% epithelioid, 17% biphasic, 12% sarcomatoid, and 17% unspecified/unknown. First-line treatment was received by 57/90 patients (63%) and 33/90 patients (37%) received the best supportive care (BSC). Chemotherapy was most used (63%) overall, but first-line immunotherapy was more commonly used since ipilimumab/nivolumab was reimbursed by the Australian Pharmaceutical Benefits Scheme in July 2021. After first-line treatment, only 40% received second-line treatment and 60% received BSC. 12-month overall survival (OS) and progression-free survival for all patients were 53% (95% confidence interval [CI]: 43-65) and 25% (95% CI 15-40) respectively. 12-month OS was 72%, 64%, and 29% for immunotherapy, chemotherapy, and BSC, respectively. There was no significant difference in survival between chemotherapy and immunotherapy (hazard ratio 1.28, 95% CI: 0.65-2.5, p = 0.5).
In our unselected real-world cohort, both chemotherapy and immunotherapy are active against PM, but the prognosis remains guarded. There remains a need for better treatment options, especially in the first-line setting. Enrolment in clinical trials is crucial to improving outcomes in this debilitating disease.
评估免疫治疗时代胸膜间皮瘤（PM）患者的真实世界治疗模式和结局。
本回顾性审计纳入了 2017 年 1 月至 2023 年 7 月期间，在澳大利亚昆士兰州的三个三级转诊中心诊断为 PM 的患者。记录患者和治疗特征及结局。采用描述性统计和 Kaplan-Meier 生存法进行数据分析。
共纳入 90 例患者：84%为男性，中位年龄 75 岁（范围 70-79 岁），85%基线 Eastern Group Cooperative Group 评分为 0-1。亚型包括 54%上皮样、17%双相型、12%肉瘤样和 17%未特指/未知。57/90 例（63%）患者接受一线治疗，33/90 例（37%）患者接受最佳支持治疗（BSC）。总体上化疗最常用（63%），但自 2021 年 7 月 ipilimumab/nivolumab 被澳大利亚药品福利计划报销以来，一线免疫治疗更为常用。一线治疗后，仅 40%的患者接受二线治疗，60%的患者接受 BSC。所有患者的 12 个月总生存率（OS）和无进展生存率分别为 53%（95%置信区间 [CI]：43-65）和 25%（95% CI 15-40）。免疫治疗、化疗和 BSC 的 12 个月 OS 分别为 72%、64%和 29%。化疗和免疫治疗的生存无显著差异（风险比 1.28，95% CI：0.65-2.5，p=0.5）。
在我们未经选择的真实世界队列中，化疗和免疫治疗均对 PM 有效，但预后仍不容乐观。特别是在一线治疗中，仍需要更好的治疗选择。入组临床试验对于改善这种使人衰弱的疾病的结局至关重要。
