1910P - Outcomes of systemic therapy after first line therapy in patients (p) with malignant pleural mesothelioma (MPM)

Background

MPM is a highly aggressive pleural tumor with limited survival despite systemic therapy. Initial reports have demonstrated beneficial effects of pemetrexed, gemcitabine and vinorelbine in previously treated MPM, but currently there is no approved therapy for 2^nd line. The aim of this study is to evaluate the outcomes of p with MPM treated in 2^nd line at our institution.

Methods

Clinical data from all 147 p with MPM diagnosed at Vall d´Hebron University Hospital between November 2002 and December 2016 were prospectively collected. 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 y), males: 70%, performance status (PS)1: 67%, asbestos exposure: 72%, epithelioid subtype: 73%. 1^st line chemotherapy was offered to 83% (cisplatin-pemetrexed 73% and carboplatin-pemetrexed 21%). Median overall survival (OS) was 16.8 months (m) (95%CI 13.2-22.2). Epithelioid histology, PS 0, neutrophil-lymphocyte ratio >5 and treatment with cisplatin vs carboplatin in 1^st line were associated with significant improvements in OS in univariate models. 2^nd line therapy was given to 91 p: clinical trial 34%, vinorelbine 24%, platinum doublet 20%, immunotherapy 15%. Median treatment-free interval between 1^st and 2^nd line was 3.3 m. Median OS for 2^nd line was 12.4 m (9.7-15.7 m). There was a trend for platinum doublet rechallenge in p with a partial response to 1^st line (p = 0.07). Median OS for p treated with platinum-pemetrexed in 2^nd line was 19.1 m vs 9.5 m for p treated with other regimens (HR 2.5, p=0.03). In this subpopulation, stage at diagnosis was also prognostic (OS 21.7 m vs 14 m stage II-III vs IV (HR 2.35, p=0.07). Median OS for platinum in 2^nd line vs no platinum was 17.3 vs 10.1m (HR0.49, CI95% 0.29-0.83, p=0.0078). As in 1^st line, p selected for of cisplatin-pemetrexed showed better OS than carboplatin-pemetrexed (34.1 vs 15.5 m, HR 1.8, 95% CI 0.4-7.6, p=0.4).

Conclusions

In our real-world experience of previously treated MPM p, chemotherapy was feasible in 2^nd line and possibility of retreatment with platinum pemetrexed associates with superior outcomes compared to other regimens.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

S. Cedres: Advisory/Consultancy: Bristol-Myers Squibb Recipient; Advisory/Consultancy, Travel/Accommodation/Expenses: F. Hoffmann La Roche AG ; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy: Boehringer Ingelheim ; Honoraria (self): MSD Oncology; Advisory/Consultancy: Amphera. P. Iranzo: Advisory/Consultancy, Travel/Accommodation/Expenses: Bristol-Myers Squibb Recipient; Advisory/Consultancy: F. Hoffmann La Roche AG ; Advisory/Consultancy, Travel/Accommodation/Expenses: Merck Sharp & Dohme ; Advisory/Consultancy, Travel/Accommodation/Expenses: Boehringer Ingelheim ; Advisory/Consultancy: MSD Oncology; Advisory/Consultancy: Rovi; Advisory/Consultancy: Kyowa Kirin; Advisory/Consultancy, Travel/Accommodation/Expenses: Grunenthal Pharma S.A. A. Callejo: Advisory/Consultancy, Travel/Accommodation/Expenses: Bristol-Myers Squibb Recipient; Advisory/Consultancy, Travel/Accommodation/Expenses: F. Hoffmann La Roche AG ; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy, Travel/Accommodation/Expenses: Boehringer Ingelheim; Advisory/Consultancy, Travel/Accommodation/Expenses: MSD Oncology; Advisory/Consultancy: Kyowa Kirin. N. Pardo: Advisory/Consultancy: Bristol-Myers Squibb Recipient; Advisory/Consultancy, Travel/Accommodation/Expenses: F. Hoffmann La Roche AG ; Advisory/Consultancy, Leadership role: Pfizer; Advisory/Consultancy: Boehringer Ingelheim . A. Navarro: Advisory/Consultancy, Travel/Accommodation/Expenses: F. Hoffmann La Roche AG ; Advisory/Consultancy, Travel/Accommodation/Expenses: Bristol-Myers Squibb ; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer; Travel/Accommodation/Expenses: Merck Sharp & Dohme; Advisory/Consultancy: Boehringer Ingelheim; Advisory/Consultancy: Oryzon Genomics. A. Martinez-Marti: Advisory/Consultancy, Travel/Accommodation/Expenses: MSD Oncology; Advisory/Consultancy, Travel/Accommodation/Expenses: F. Hoffmann La Roche AG ; Advisory/Consultancy, Research grant/Funding (self): Bristol-Myers Squibb Recipient; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer ; Advisory/Consultancy, Research grant/Funding (self): Boehringer Ingelheim. R. Dienstmann: Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche; Advisory/Consultancy: Boehringer Ingelheim; Speaker Bureau/Expert testimony: Ipsen; Speaker Bureau/Expert testimony: Amgen; Speaker Bureau/Expert testimony: Servier; Speaker Bureau/Expert testimony, Research grant/Funding (institution): Merck Sharp Dohme; Research grant/Funding (institution): Pierre Fabre. E. Felip: Advisory/Consultancy: AbbVie; Advisory/Consultancy, Speaker Bureau/Expert testimony: AstraZeneca; Advisory/Consultancy: blueprint; Advisory/Consultancy, Speaker Bureau/Expert testimony: Boehringer Ingelheim ; Advisory/Consultancy, Speaker Bureau/Expert testimony: Bristol-Myers Squibb; Advisory/Consultancy: Celgene; Advisory/Consultancy: Eli Lilly; Advisory/Consultancy: guardant health; Advisory/Consultancy: Merck; 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.