The addition of chemotherapy to active symptom control (ASC) for mesothelioma patients does not appear to improve their survival or quality of life. These are the conclusions of authors of an article in this week’s edition of The Lancet.
Worldwide incidence of malignant pleural mesothelioma (MPM) continues to rise – in the UK, the mortality rate increased 12-fold between 1968 and 2001; nearly 2000 deaths were recorded in 2005. This yearly death rate is expected to increase to a peak of 2200 by 2013. Similar death rates occur in the USA and Western Europe.
In future decades the epidemic will shift towards countries that still produce or use large quantities of asbestos, such as Russia, China, Canada, Kazakhstan, Brazil, Zimbabwe, India, and Thailand.
Richard Stephens and Professor Mahesh Parmar, Medical Research Council (MRC) Clinical Trials Unit, London, UK, and colleagues did the MS01 study, a Cancer Research UK-funded, randomised trial involving 409 patients with MPM from 76 centres in the UK and two in Australia.
Of these, 136 were randomised to ASC alone. A further 137 received ASC plus MVP chemotherapy (four cycles of mitomycin, vinblastine, and cisplatin every three weeks); and the remaining patients (136) received ASC plus vinorelbine chemotherapy (one injection of vinorelbine every week for 12 weeks).
At the time of analysis, 393 (96%) of patients had died – 132 (97%) of the ASC only group; 132 (96%) in the ASC/MVP group; and 129 (95%) in the ASC/vinorelbine group. A small but non-statistically-significant benefit was seen in the ASC plus chemotherapy group versus ASC alone (29% of ASC patients were alive at 1 year compared to 32% of those on ASC plus chemotherapy). Patients in the ASC/vinorelbine showed a trend towards improved survival compared with ASC alone, and 37% of these patients were alive at 1 year, although this was not statistically significant. Quality of life scores (physical functioning, pain, shortness of breath, overall health status) were similar in the three groups.
The authors conclude: “The addition of chemotherapy to ASC offers no significant benefits in terms of overall survival or quality of life. However, exploratory analyses suggested that vinorelbine merits further investigation.”