Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations
BackgroundMalignant pleural mesothelioma (MPM) is associated with poor prognosis despite advances in multimodal therapeutic strategies. While patients with resectable disease may benefit from added survival with oncologic resection, patient selection for mesothelioma operations often relies on both...
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1216999/full |
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| author | Nathaniel Deboever Nicolas Zhou Daniel J. McGrail Katarzyna Tomczak Jacqueline L. Oliva Hope A. Feldman Edwin Parra Jianjun Zhang Percy P. Lee Mara B. Antonoff Wayne L. Hofstetter Reza J. Mehran Ravi Rajaram David C. Rice Jack A. Roth Stephen S. Swisher Ara A. Vaporciyan Mehmet Altan Annikka Weissferdt Anne S. Tsao Cara L. Haymaker Boris Sepesi |
| author_facet | Nathaniel Deboever Nicolas Zhou Daniel J. McGrail Katarzyna Tomczak Jacqueline L. Oliva Hope A. Feldman Edwin Parra Jianjun Zhang Percy P. Lee Mara B. Antonoff Wayne L. Hofstetter Reza J. Mehran Ravi Rajaram David C. Rice Jack A. Roth Stephen S. Swisher Ara A. Vaporciyan Mehmet Altan Annikka Weissferdt Anne S. Tsao Cara L. Haymaker Boris Sepesi |
| author_sort | Nathaniel Deboever |
| collection | DOAJ |
| description | BackgroundMalignant pleural mesothelioma (MPM) is associated with poor prognosis despite advances in multimodal therapeutic strategies. While patients with resectable disease may benefit from added survival with oncologic resection, patient selection for mesothelioma operations often relies on both objective and subjective evaluation metrics. We sought to evaluate factors associated with improved overall survival (OS) in patients with mesothelioma who underwent macroscopic complete resection (MCR).MethodsPatients with MPM who received neoadjuvant therapy and underwent MCR were identified in a prospectively maintained departmental database. Clinicopathologic, blood-based, and radiographic variables were collected and included in a Cox regression analysis (CRA). Response to neoadjuvant therapy was characterized by a change in tumor thickness from pretherapy to preoperative scans using the modified RECIST criteria.ResultsIn this study, 99 patients met the inclusion criteria. The median age of the included patients was 64.7 years, who were predominantly men, had smoking and asbestos exposure, and who received neoadjuvant therapy. The median change in tumor thickness following neoadjuvant therapy was –16.5% (interquartile range of -49.7% to +14.2%). CRA demonstrated reduced OS associated with non-epithelioid histology [hazard ratio (HR): 3.06, 95% confidence interval (CI): 1.62–5.78, p < 0.001] and a response to neoadjuvant therapy inferior to the median (HR: 2.70, CI: 1.55–4.72, p < 0.001). Patients who responded poorly (below median) to neoadjuvant therapy had lower median survival (15.8 months compared to 38.2 months, p < 0.001).ConclusionPoor response to neoadjuvant therapy in patients with MPM is associated with poor outcomes even following maximum surgical cytoreduction and should warrant a patient-centered discussion regarding goals of care and may therefore help guide further therapeutic decisions. |
| first_indexed | 2024-03-12T15:09:58Z |
| format | Article |
| id | doaj.art-31d96bb81be04ff5b9ce89f4dbae9747 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-12T15:09:58Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-31d96bb81be04ff5b9ce89f4dbae97472023-08-11T17:51:48ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-08-011310.3389/fonc.2023.12169991216999Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operationsNathaniel Deboever0Nicolas Zhou1Daniel J. McGrail2Katarzyna Tomczak3Jacqueline L. Oliva4Hope A. Feldman5Edwin Parra6Jianjun Zhang7Percy P. Lee8Mara B. Antonoff9Wayne L. Hofstetter10Reza J. Mehran11Ravi Rajaram12David C. Rice13Jack A. Roth14Stephen S. Swisher15Ara A. Vaporciyan16Mehmet Altan17Annikka Weissferdt18Anne S. Tsao19Cara L. Haymaker20Boris Sepesi21Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesBackgroundMalignant pleural mesothelioma (MPM) is associated with poor prognosis despite advances in multimodal therapeutic strategies. While patients with resectable disease may benefit from added survival with oncologic resection, patient selection for mesothelioma operations often relies on both objective and subjective evaluation metrics. We sought to evaluate factors associated with improved overall survival (OS) in patients with mesothelioma who underwent macroscopic complete resection (MCR).MethodsPatients with MPM who received neoadjuvant therapy and underwent MCR were identified in a prospectively maintained departmental database. Clinicopathologic, blood-based, and radiographic variables were collected and included in a Cox regression analysis (CRA). Response to neoadjuvant therapy was characterized by a change in tumor thickness from pretherapy to preoperative scans using the modified RECIST criteria.ResultsIn this study, 99 patients met the inclusion criteria. The median age of the included patients was 64.7 years, who were predominantly men, had smoking and asbestos exposure, and who received neoadjuvant therapy. The median change in tumor thickness following neoadjuvant therapy was –16.5% (interquartile range of -49.7% to +14.2%). CRA demonstrated reduced OS associated with non-epithelioid histology [hazard ratio (HR): 3.06, 95% confidence interval (CI): 1.62–5.78, p < 0.001] and a response to neoadjuvant therapy inferior to the median (HR: 2.70, CI: 1.55–4.72, p < 0.001). Patients who responded poorly (below median) to neoadjuvant therapy had lower median survival (15.8 months compared to 38.2 months, p < 0.001).ConclusionPoor response to neoadjuvant therapy in patients with MPM is associated with poor outcomes even following maximum surgical cytoreduction and should warrant a patient-centered discussion regarding goals of care and may therefore help guide further therapeutic decisions.https://www.frontiersin.org/articles/10.3389/fonc.2023.1216999/fullmalignant pleural mesotheliomaneoadjuvant therapyradiographic responsecytoreductive resectionpatient-centered care |
| spellingShingle | Nathaniel Deboever Nicolas Zhou Daniel J. McGrail Katarzyna Tomczak Jacqueline L. Oliva Hope A. Feldman Edwin Parra Jianjun Zhang Percy P. Lee Mara B. Antonoff Wayne L. Hofstetter Reza J. Mehran Ravi Rajaram David C. Rice Jack A. Roth Stephen S. Swisher Ara A. Vaporciyan Mehmet Altan Annikka Weissferdt Anne S. Tsao Cara L. Haymaker Boris Sepesi Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations Frontiers in Oncology malignant pleural mesothelioma neoadjuvant therapy radiographic response cytoreductive resection patient-centered care |
| title | Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations |
| title_full | Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations |
| title_fullStr | Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations |
| title_full_unstemmed | Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations |
| title_short | Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations |
| title_sort | radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations |
| topic | malignant pleural mesothelioma neoadjuvant therapy radiographic response cytoreductive resection patient-centered care |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1216999/full |
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