Real world use of systemic therapy in elderly patients with malignant pleural mesothelioma (MPM)

Date 28 September 2019
Event ESMO 2019 Congress
Session Poster Display session 1
Topics Mesothelioma
Presenter Susana Cedres
Citation Annals of Oncology (2019) 30 (suppl_5): v747-v755. 10.1093/annonc/mdz266
Authors S. Cedres1, J.D. Assaf2, P. Iranzo3, A. Callejo4, N. Pardo1, A. Navarro4, A. Martinez-Marti4, G. Rodriguez4, V. Monton4, J. Gonzalo5, J.M. Miquel5, A. Pedrola5, R. Dienstmann6, E. Felip7
  • 1Medical Oncology, Vall d'Hebron Institute of Oncology and University Hospital, 08035 - Barcelona/ES
  • 2Oncology, Vall d'Hebron University Hospital, 08035 - BARCELONA/ES
  • 3Medical Oncology, Vall d'Hebron Institute of Oncology and University Hospital, 08026 - barcelona/ES
  • 4Medical Oncology, Vall d'Hebron Institute of Oncology and University Hospital, 08019 - Barcelona/ES
  • 5Medical Oncology, Vall d'Hebron Institute of Oncology, 08019 - Barcelona/ES
  • 6Oncology Data Science, Vall d'Hebron University Hospital, 08019 - Barcelona/ES
  • 7Medical Oncology Service (lung Cancer Unit)  , Vall d'Hebron University Hospital, 08019 - Barcelona/ES

Abstract

Background

MPM is a highly aggressive pleural tumor associated with asbestos exposure and with limited survival despite systemic therapy. The incidence of MPM in elderly is increasing and these patients (p) require special consideration due to multiple comorbidities and increased risk of toxicities. The objective of this study is to characterize elderly p diagnosed with MPM at our institution and evaluate overall survival in this population.

Methods

One hundred forty-seven MPM p diagnosed at Vall d´Hebron Institute of Oncology between November 2002 and December 2016 were reviewed. Associations between clinical variables and outcome were assessed with Cox regression models and survival data were calculated by the Kaplan-Meier method.

Results

Patient’s characteristics: median age 68 years (y) (51-86 years), males: 70%, performance status (PS)1: 67%, asbestos exposure: 72%, epithelioid subtype: 73%. First line chemotherapy was offered to 83% of p (73% cisplatin-pemetrexed and 21% carboplatin-pemetrexed). Median progression free survival (PFS) first line was 4.9 months (m;CI95% 3.6-5.6). Clinical trial was offered as second-line regimen in 34%. Median survival (OS) in overall population was 16.8 m (95%CI13.2-22.2) and in those treated with chemotherapy was 20.6 m (95%17.1-23.6). Epitheliod histology, PS 0, neutrophil-lymphocyte ratio >5 and treatment with cisplatin vs carboplatin were associated with significant improvements in OS. In total, 59 p were >70y, 42 p > 75y and 19 p > 80y. Elderly p (>70y) received first line in 66% of cases, with carboplatin-pemetrexed in 76%. Median PFS in first line was 4.8 m (95%CI 3.7-4.7m). No differences in treatment discontinuation by toxicity neither dose reductions were found (6% vs 4% and 6 vs 7% in elderly vs < 70y, respectively). Second line was given in 42% of elderly. Median OS in elderly p receiving chemotherapy was 15.1 m vs 2.7 m with best supportive care (p < 0.001). Epithelioid histology, PS 0 and eligibility to first line chemotherapy were significant prognostic factors in elderly p (p < 0.001).

Conclusions

In our real world experience, chemotherapy was feasible in most elderly p with MPM and does not associates with inferior outcomes or higher toxicity compared to younger population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

S. Cedres: Advisory / Consultancy, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: Bristol-Myers Squibb; Speaker Bureau / Expert testimony: Boehringer Ingelheim; Advisory / Consultancy, Travel / Accommodation / Expenses: Pfizer; Speaker Bureau / Expert testimony: Apmhera; Advisory / Consultancy: Lilly; Honoraria (institution): Merck. P. Iranzo: Advisory / Consultancy: Roche; Advisory / Consultancy: Grunenthal; Advisory / Consultancy, Travel / Accommodation / Expenses: Kyowa Kirin; Advisory / Consultancy: Rovi; Advisory / Consultancy, Travel / Accommodation / Expenses: MSD; Advisory / Consultancy, Travel / Accommodation / Expenses: Pierre Fabre. A. Callejo: Advisory / Consultancy: Roche ; Advisory / Consultancy: Pfizer; Travel / Accommodation / Expenses: MSD; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Bristol-Myers Squibb. N. Pardo: Advisory / Consultancy, Travel / Accommodation / Expenses: roche; Advisory / Consultancy, Travel / Accommodation / Expenses: Pfizer; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Bristol Myers Squibb. A. Navarro: Advisory / Consultancy: Roche; Advisory / Consultancy, Travel / Accommodation / Expenses: Pfizer; Advisory / Consultancy, Travel / Accommodation / Expenses: Boehringer Ingelheim; Advisory / Consultancy: Bristol-Myers Squibb ; Speaker Bureau / Expert testimony: Orizon Genomics. A. Martinez-Marti: Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Roche ; Advisory / Consultancy, Travel / Accommodation / Expenses: MSD; Advisory / Consultancy: Pfizer; Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Boehringer Ingelheim ; Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Bristol-Myers Squibb; Advisory / Consultancy, Travel / Accommodation / Expenses: Merck Sharp. R. Dienstmann: Advisory / Consultancy, Speaker Bureau / Expert testimony: Roche; Advisory / Consultancy: Novartis; Speaker Bureau / Expert testimony: Symphogen; Speaker Bureau / Expert testimony: Ipsen; Speaker Bureau / Expert testimony: Amgen; Speaker Bureau / Expert testimony: Sanofi; Speaker Bureau / Expert testimony: MSD; Speaker Bureau / Expert testimony: Servier; Research grant / Funding (institution): Merck. E. Felip: Advisory / Consultancy, Speaker Bureau / Expert testimony: Abbvie; Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca; Advisory / Consultancy: Blue Print Medicines; Advisory / Consultancy, Speaker Bureau / Expert testimony: Boehringer Ingelheim; Advisory / Consultancy: Celgene; Advisory / Consultancy, Speaker Bureau / Expert testimony: Eli Lilly; Advisory / Consultancy: guardant health ; Advisory / Consultancy, Speaker Bureau / Expert testimony: Merck KgaA; Advisory / Consultancy, Speaker Bureau / Expert testimony: Merck, Sharp and Dohme; Advisory / Consultancy, Speaker Bureau / Expert testimony: Novartis; Advisory / Consultancy, Speaker Bureau / Expert testimony: Pfizer; Advisory / Consultancy, Speaker Bureau / Expert testimony: Roche; Advisory / Consultancy, Speaker Bureau / Expert testimony: Takeda; Advisory / Consultancy: Janssen. All other authors have declared no conflicts of interest.