Real-life treatment practice for malignant pleural mesothelioma in Belgium. (November 2018) - Rosskamp, Michael
Highlights: Sixty-nine percent of MPM patients underwent tumour-directed treatment. Multimodal therapy including radical surgery was reserved to a minority of patients. Cisplatin-pemetrexed combination emerged as standard first-line chemotherapy. Age, gender and morphology had a significant impact on survival. Chemotherapy was the only treatment with independent prognostic value. Abstract: Objectives: Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer, for which treatment is often limited to palliative combination chemotherapy. Multimodality-therapy, including radical surgery, is largely restricted to clinical trials, leaving its benefit currently unclear. This study aimed to get a comprehensive view on real-world MPM treatment at the Belgian population level, to assess survival and to identify prognostic factors. Materials and methods: The study period covered the incidence years 2004–2012 (N = 1453). Starting from the Belgian Cancer Registry, additional information regarding patient characteristics, diagnosis and treatment was retrieved from multiple data sources. Adjusted cox proportional-hazard regression models using time-dependent covariates were performed to assess survival in relation to treatment patterns and centre volume. Results: Sixty-nine percent of patients underwent tumour-directed treatment, mostly cisplatin-pemetrexed chemotherapy. Radical surgery was mainly performed in younger patients with epithelioid subtype. Centre volume, surgery and chemotherapy showed a positive relation with survival in univariable analyses, but only chemotherapy remained significantly relevant in multivariable analyses. Younger patients, females, and epithelioid subtypes also independently had a better survival. Conclusion: This large population-based study provides insights in MPM treatment practice in Belgium. Centre volume and surgery being related to survival in univariable analyses, only chemotherapy remained prognostic after adjustment.