Journal of the National Cancer Institute 2020 February 3 [Link]
Voigt SL, Raman V, Jawitz OK, Bishawi M, Yang CJ, Tong BC, D’Amico T, Harpole DH
There is no standard of care with respect to the use of neoadjuvant chemotherapy (NAC) in resectable malignant pleural mesothelioma (MPM). We performed an intention-to-treat analysis with data from a single institution and the National Cancer Database (NCDB) to identify whether the use of NAC impacts survival in resectable MPM.
Patients with MPM who had surgery with curative intent at Duke University from 1995-2017 were selected, and the 2004-2015 NCDB was used to identify MPM patients with clinical stage I-IIIB who underwent definitive surgery. For both cohorts, patients were stratified by receipt of neoadjuvant chemotherapy. Primary outcomes were overall survival (OS) and post-resection survival (RS), which were estimated using Kaplan-Meier and multivariable Cox Proportional Hazards models.
257 patients met inclusion criteria in the Duke cohort. Compared to immediate resection (IR), NAC was associated with similar OS but an increased risk for post-resection mortality in both unmatched (adjusted HR = 1.85; 95%CI=1.21-2.83) and propensity-matched (HR 1.62; 95%CI 1.03-2.55) cohorts. A total of 1949 NCDB patients were included: 1597 (81.9%) IR and 352 (18.1%) NAC. Post-resection survival was worse for patients undergoing NAC in both unmatched (HR 1.85; 95%CI 1.21-2.83) and propensity-matched (HR 1.29; 95%CI 1.06-1.57) analyses compared to patients receiving IR.
In this intention-to-treat study, NAC was associated with worse post-resection survival compared to IR in patients with MPM. The risks and benefits of induction therapy should be weighed before offering it to patients with resectable MPM.