KEY TAKEAWAYS
- The phase II trial aimed to evaluate the optimal timing of chemotherapy in pts with operable malignant pleural mesothelioma by comparing neoadjuvant versus adjuvant chemotherapy.
- The primary endpoint was the rate of success of this treatment.
- The study demonstrated the feasibility of surgery using eP/D in mesothelioma pts.
Combined therapy is the standard approach in early-stage malignant pleural mesothelioma(MPM), but optimal treatment strategies remain undefined. The role and timing of maximal debulking surgery, particularly extended pleurectomy/decortication(eP/D) over extrapleural pneumonectomy, are still debated due to conflicting evidence.
Researchers aimed to evaluate the optimal timing of chemotherapy in patients(pts) with operable MPM by comparing neoadjuvant versus adjuvant chemotherapy.
The study included operable MPM pts of clinical stage T1-3 N0-1 M0, and they were randomly assigned to either immediate surgery (Arm A) followed by chemotherapy (3 cycles of cisplatin 75 mg/m² or carboplatin AUC 5 plus pemetrexed 500 mg/m²) or deferred surgery (Arm B) preceded by the same chemotherapy. The primary endpoint aimed to assess the success rate of this treatment approach, with a sample size of 64 pts estimated to confirm the superiority of either arm. The current report focused on presenting the surgical outcomes.
About 69 pts from 5 centers across Belgium, the Netherlands, and Egypt were randomized in the trial, with 34 in arm A and 35 in arm B. In arm A, surgery was performed on 30 pts; in arm B, surgery was performed on 28 pts, with median durations of 372 and 339 minutes, respectively. Diaphragm resection occurred in 26 versus 21 pts, pericardium resection in 16 pts, and lung parenchyma resection in 13 pts each. Median total intraoperative blood loss was 1700 versus 1475 ml in arms A and B, respectively. The completeness of macroscopic resection was reported as 86.7% versus 78.6%, with total complications observed in 76.7% versus 92.9% and technical difficulties in 13.3% versus 28.6%. The median hospital stay was 14 versus 13 days. One patient in arm A (1.7%) died within 30 days of surgery due to a myocardial infarction. The overall mortality rate in operated pts was 1.7%. About 21 serious adverse events(AEs) (30.4%) occurred in the entire study population.
The study demonstrated the feasibility of surgery using eP/D in mesothelioma pts, but its complexity necessitates its execution in specialized centers.
Source: https://cattendee.abstractsonline.com/meeting/10925/presentation/1032
Clinical Trial: https://clinicaltrials.gov/study/NCT02436733
Raskin J, Maat APWM, Surmont V, Burgers SA, Yahia M, Pretzenbacher Y, Cornelissen R, De Ryck F, Klomp HM, Marreaud S, Baas P, Aerts J, Oliveira A, Van Meerbeeck JP, Van Schil P. Surgical Results of EORTC 1205, a Randomized Phase II Study of Surgery for Mesothelioma Preceded or Followed by Chemotherapy. IASLC.2023.
