Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Second-line chemotherapy for malignant pleural mesothelioma (MPM): Patterns of care in two Australian tertiary institutions (#194)

David Palmieri 1 , Rina Hui 1 2 , Steven Kao 3 4 5 , Michael Boyer 3 4 , John Park 1 , Adnan Nagrial 1 4
  1. Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
  2. University of Sydney, Sydney, NSW , Australia
  3. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  4. University of Sydney, Sydney, NSW, Australia
  5. Asbestos Diseases Research Institute, Sydney, NSW, Australia


MPM is an aggressive malignancy with poor prognosis. In advanced disease, cisplatin/pemetrexed chemotherapy has been shown to improve overall survival (OS) and improve quality of life. On disease progression there is no standard second-line (2L) treatment.


We performed a retrospective chart review of patients with histologically confirmed MPM seen at two large cancer centres in Sydney, who received palliative chemotherapy from 2000-2012. Patient demographic, clinical, treatment and survival data were collected. The association between several variables (age, gender, histology, response to and PFS from first-line therapy) and response to 2L therapy was determined. 


133 patients with a median age of 67 were identified (83% male, 17% female). There was a history of asbestos exposure in 88%, and ECOG performance status was 0 (14.7%), 1 (74.4%) and 2 (10.1%). Tumour histopathology was predominantly epitheliod (61.7%). Median PFS from first-line chemotherapy was 7.4 months and median OS 11.6 months. Patients received carboplatin/pemetrexed (51.1%), cisplatin/pemetrexed (35.3%), carboplatin/gemcitabine (5.3%) and other agents (8.3%) as first-line treatment with an objective response rate (ORR) of 38.5% and disease control rate (DCR) of 77.9%. 55 patients (52.6%) received 2L chemotherapy. Carboplatin/gemcitabine (47.1%), carboplatin/pemetrexed (34.3%) and pemetrexed alone (4.3%) were the most commonly used regimens. The ORR to 2L therapy was 23.8% and DCR 66.7%. The only factor associated with response to 2L therapy on univariate analysis was PFS>6 months from first-line chemotherapy (OR10.1; P0.02). 25 patients received third-line chemotherapy (ORR 19.1%, DCR 47.6%) and 7 patients fourth-line chemotherapy (ORR 0%, DCR 20.0%). 


Approximately half of the patients in this cohort received 2L chemotherapy, with response rates higher than reported in previous retrospective series. PFS >6 months from first-line therapy was the only variable associated with response to 2L treatment. Prospective trials are required to formally evaluate the role of chemotherapy in pre-treated MPM.