Multimodal Treatment of Malignant Pleural Mesothelioma: Real-World Experience with 112 Patients

SIMPLE SUMMARY: To evaluate the best possible treatment of malignant pleural mesothelioma—a cancer whose development is associated with asbestos exposure—an analysis of 112 consecutive patients treated at a high-volume center in Vienna (Austria) was conducted. The average survival of all patients was 16.9 months after diagnosis. Of the patients who underwent combined chemotherapy and lung-preserving surgery, 29% were still alive 5 years after diagnosis. In statistical analysis, combined chemotherapy and surgery, epithelioid tumor subtype, early tumor stage and the absence of relevant comorbidities were found to be favorable factors for survival. Therefore, the best possible treatment for malignant pleural mesothelioma should incorporate multiple therapeutic approaches. ABSTRACT: Malignant pleural mesothelioma (MPM) is a rare pleural cancer associated with asbestos exposure. According to current evidence, the combination of chemotherapy, surgery and radiotherapy improves patients’ survival. However, the optimal sequence and weighting of the respective treatment modalities is unclear. In anticipation of the upcoming results of the MARS-2 trial, we sought to determine the relative impact of the respective treatment modalities on complications and overall survival in our own consecutive institutional series of 112 patients. Fifty-seven patients (51%) underwent multimodality therapy with curative intent, while 55 patients (49%) were treated with palliative intent. The median overall survival (OS) of the entire cohort was 16.9 months (95% CI: 13.4–20.4) after diagnosis; 5-year survival was 29% for patients who underwent lung-preserving surgery. In univariate analysis, surgical treatment (p < 0.001), multimodality therapy (p < 0.001), epithelioid subtype (p < 0.001), early tumor stage (p = 0.02) and the absence of arterial hypertension (p = 0.034) were found to be prognostic factors for OS. In multivariate analysis, epithelioid subtype was associated with a survival benefit, whereas the occurrence of complications was associated with worse OS. Multimodality therapy including surgery significantly prolonged the OS of MPM patients compared with multimodal therapy without surgery.