Patients with advanced malignant pleural mesothelioma (MPM) treated with a combination of surgery to remove the cancer but save their lung, plus photodynamic therapy and chemotherapy, had a median survival of nearly 3 years, with a subset of patients living longer than 7 years (Annals of Thoracic Surgery 2016; DOI: 10.1016/j.athoracsur.2016.08.071).
"These are among the best results ever published for patients with an epithelial subtype of pleural mesothelioma, which accounts for about two-thirds of all cases," noted the lead author, Joseph S. Friedberg, MD, the Charles Reid Edwards Professor of Surgery and Head of the Division of Thoracic Surgery at the University of Maryland School of Medicine and Thoracic Surgeon-in-Chief of the University of Maryland Medical System.
"This is among the most virulent cancers known to man, and we have a long way to go, but it's encouraging to have achieved results we can report in years not months even for these patients with such advanced disease," Friedberg said. "Although, from a technical perspective, it is more challenging to save the lung than to sacrifice it, it does appear that this technique helps to not only extend life but to also preserve quality of life."
Cancer Study Specifics
The study followed 73 patients with MPM who had surgery to remove the cancer, followed by a therapy using a photosensitizing agent and light to kill microscopic cancer cells. Ninety-two percent of the patients also received chemotherapy.
Overall median survival for all the patients in the study was nearly 3 years (35 months), the researchers report, but that figure more than doubled, to 7.3 years, for 19 of these patients whose cancer had not spread to their lymph nodes. In addition, researchers also found that overall survival was three times higher than disease-free survival.
For the 73 patients in the study, median disease-free survival was 1.2 years, a third of the overall survival of 3 years. In the group of 19 patients with overall survival of 7.3 years, disease-free survival was 2.3 years. The majority of the patients had stage III or stage IV disease.
"It's unusual to find such a difference in between overall and disease-free survival rates. When this cancer recurs, which it almost always does, patients usually live only a few months," noted Friedberg of the study results.
While the researchers caution against drawing definitive conclusions based on this non-randomized study, they are intrigued by the findings. Friedberg and his colleagues are now looking for mechanisms behind the difference to work on improving survival even more.
Lung-Sparing Surgery
Friedberg performed the lung-sparing surgery on the patients in the study while he was at the University of Pennsylvania, where the research was conducted. He has pioneered lung-sparing surgery for mesothelioma and now serves as Director of the Mesothelioma and Thoracic Oncology Treatment and Research Center at the University of Maryland School of Medicine, Baltimore. The center is part of the University of Maryland Greenebaum Comprehensive Cancer Center.
The lung-sparing surgery is a 6- to 14-hour operation to remove detectable cancer from the lining of the chest and spares the lung and as many other normal structures as possible. Friedberg developed his lung-sparing technique as an alternative to removing the entire lung, diaphragm, and sac around the heart.
Friedberg and his colleagues say that this study shows the lung-sparing technique can be safely used to achieve a "macroscopic complete resection" while preserving the lung. "The role for lung-sparing surgery for mesothelioma has not been completely defined, but this series demonstrates that it is an option, even in advanced stage cases," researchers concluded.
Have Stories Delivered Directly to You
Sign up for our free e-newsletter and receive email notifications when each issue becomes available and when other new content is posted online. New to Oncology Times? Visit the publication's website at http://www.oncology-times.com where you can get free access to archived issues, subscribe to the print magazine, and create your own personal online article collections.