Abstract 1909P
Background
MPM has an aggressive nature with a poor prognosis. Describing current disease management is critical for understanding the burden of disease. As part of I-O Optimise, a multinational research initiative providing insights into real-world lung cancer management, this study provides an overview of the MPM population, treatment patterns, and overall survival (OS) in England.
Methods
This retrospective cohort study used data from the national Cancer Analysis System (CAS) registry and included all adult patients (pts) diagnosed with MPM in England from Jan 2013 to Dec 2017, with follow-up to Mar 2018. Pt characteristics and initial treatment were described; OS was estimated using Kaplan-Meier methods. Analyses on systemic anticancer therapy (SACT) received and OS by line of therapy are ongoing.
Results
9458 pts diagnosed with MPM were analysed: median age was 75 years; ECOG performance status (PS) was 0–1 in 44.5%, 2 in 11.5%, >2 in 9.1%, and missing in 34.8%; TNM stage was not reported for 60.4%; histopathology distributions are presented (Table). Pts with sarcomatoid or not otherwise specified (NOS) MPM tended to be older with a higher ECOG PS than pts with biphasic or epithelioid MPM. In total, 6.5% of pts had surgery (mostly decortication or open excision of pleura; <6 pts had total pneumonectomy) and 34.9% received SACT. The proportion receiving best supportive care (BSC) or radiotherapy (RT) alone was high (60.1%) and varied by age, ECOG PS, and histopathology (79.9% of pts ≥75 years, 69.1% with ECOG PS 2, 95.4% with ECOG PS >2, 65.2% with sarcomatoid MPM, and 70.0% with NOS MPM). Overall, median OS was 8.3 months. OS by histopathology and initial treatment are presented (Table). Among pts able to receive SACT (± RT), OS remained poor with 10–13% alive 3 years after diagnosis.
Conclusions
This nationwide study highlights significant unmet needs in MPM and the difficulty managing the disease. Treatment rates were low and OS poor for all pt groups Table: 1909P
| N | % | OS in months Median (Q1-Q3) | 1-year OS (%) [95% CI] | 3-year OS (%) [95% CI] | |
| Histopathology | |||||
| Epithelioid | 3439 | 36 | 13.2 (6.5-23.4) | 54 [53-56] | 12 [11-14] |
| Sarcomatoid | 883 | 9 | 4.3 (2.0-8.2) | 15 [12-17] | 2 [1-4] |
| Biphasic | 693 | 7 | 8.3 (3.9-14.7) | 32 [29-36] | 3 [1-5] |
| NOS | 4093 | 43 | 5.8 (1.9-14.4) | 30 [29-32] | 6 [6-7] |
| Initial treatment | |||||
| Surgery + SACT | 135 | 1 | 21.5 (13.0-35.1) | 79 [72-86] | 20 [11-34] |
| Surgery ± RT | 478 | 5 | 15.3 (7.4-30.2) | 60 [55-64] | 19 [15-23] |
| SACT + RT | 1099 | 12 | 15.7 (10.0-25.9) | 65 [62-68] | 13 [11-16] |
| SACT alone | 2059 | 22 | 12.9 (7.3-21.4) | 53 [51-56] | 10 [9-12] |
| RT alone | 1077 | 11 | 10.0 (4.8-18.3) | 44 [41-47] | 7 [6-9] |
| BSC | 4604 | 49 | 3.8 (1.4-9.6) | 20 [18-21] | 5 [4-5] |
Clinical trial identification
Editorial acknowledgement
Professional editorial assistance was provided by Richard Daniel, PhD, of Parexel, funded by Bristol-Myers Squibb.
Legal entity responsible for the study
Bristol-Myers Squibb Company.
Funding
Bristol-Myers Squibb Company.
Disclosure
P. Baas: Advisory/Consultancy: Bristol-Myers Squibb; Advisory/Consultancy: Takeda; Travel/Accommodation/Expenses: Takeda. M. Daumont: Shareholder/Stockholder/Stock options: Bristol-Myers Squibb; Full/Part-time employment: Bristol-Myers Squibb. L. Lacoin, J.R. Penrod, R. Carroll, N. Tanna: Full/Part-time employment: Bristol-Myers Squibb. S. Venkatesan, H. Ubhi: Research grant/Funding (institution), Full/Part-time employment: IQVIA. A. Calleja: Full/Part-time employment: IQVIA. M. Snee: Full/Part-time employment: IQVIA; Advisory/Consultancy: Bristol-Myers Squibb.