Inclusion of anti-vascular therapy as a promising option for later-line treatment of malignant pleural mesothelioma: a retrospective study

Journal of Thoracic Disease 2025 August 31 [Link]

Keda Shao, Di Wu, Qian Wang, Dong Wang, Yue Hao, Bihui Li, Jianhui Huang, Ziyan Yang, Jingxun Wu, Long Huang, Wenfeng Li, Rui Meng, Jian Feng, Jianfei Fu, Huijing Feng, Shengjie Yang, Ling Xu, Xuefei Shi, Miao Li, Yujuan Wang, Chunwei Xu, Zhengbo Song

Abstract

Background: Malignant pleural mesothelioma (MPM) is a highly aggressive malignancy with a poor prognosis. While pemetrexed-based chemotherapy and dual immunotherapy are established first-line treatments, optimal second- and later-line therapies remain underexplored. This study aims to evaluate later-line treatment options for MPM.

Methods: We retrospectively evaluated the outcomes of 85 patients with MPM who had failed in the first-line treatment between 2006 and 2023 in six hospitals. Survival outcomes were analyzed using Kaplan-Meier methodology, with between-group comparisons performed via log-rank testing. The Cox proportional hazards model was employed for both univariate and multivariate analyses to identify prognostic factors. Treatment response was assessed using standard efficacy endpoints: objective response rate (ORR) and disease control rate (DCR).

Results: This retrospective analysis evaluated 85 patients with advanced MPM. The cohort demonstrated a median progression-free survival (PFS) of 3.73 months and a median overall survival (OS) of 12.4 months. In the later-line, combining chemotherapy with anti-vascular therapy showed significant efficacy in median PFS than the chemotherapy scheme (4.57 vs. 3.00 months, P=0.004), as well as differences in median OS (13.00 vs. 10.03 months, P=0.04).

Conclusions: For patients with MPM requiring later-line treatment, the combination of chemotherapy and anti-vascular therapy may represent a viable therapeutic alternative, demonstrating an acceptable safety profile.