How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma?

Sharkey, Annabel J., O’Byrne, Kenneth J., Nakas, Apostolos, Tenconi, Sara, Fennell, Dean A., & Waller, David A. (2016) How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma? Lung Cancer, 100, pp. 5-13.

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There is little evidence regarding the use of chemotherapy as part of multimodality treatment of malignant pleural mesothelioma (MPM). We aimed to determine whether, in those patients fit for chemotherapy, a delay in this treatment affected survival.

Materials and methods

We analysed postoperative variables of 229 patients undergoing either extrapleural pneumonectomy (EPP) (81 patients) or extended pleurectomy-decortication (EPD) (197 patients) for MPM at a single centre. There was no standard protocol for additional chemotherapy and varied with referral centre. Outcome was compared between 4 chemotherapy strategies: true adjuvant therapy, neo-adjuvant therapy, therapy reserved until evidence of disease progression in those otherwise fit in the post-operative setting, and those unfit for chemotherapy.


There was no effect of the timing of chemotherapy on overall or progression free survival in patients fit enough for treatment (p = 0.39 and p = 0.33 respectively). However delaying chemotherapy until evidence of disease progression in patients with non-epithelioid disease had a detrimental effect on overall survival (OS), and on progression free survival (PFS) in lymph node positive patients (15.6 vs. 8.2 months p = 0.001, and 14.9 vs. 6.0 months p = 0.016). Further analysis of 169 patients receiving platinum/pemetrexed as first line treatment, showed similar results; there was no effect of the timing of chemotherapy on OS or PFS (p = 0.80 and p = 0.53 respectively) and an improved OS in patients with non-epithelioid disease, and improved PFS in those with lymph node metastases, if chemotherapy was given in the immediate adjuvant setting (p = 0.001 and 0.038) when therapy was not delayed until disease progression.


Our results suggest that the timing of additional chemotherapy may be important in those with a poorer prognosis on the basis of cell type and nodal stage. In these patients additional postoperative chemotherapy should not be delayed.

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ID Code: 98798
Item Type: Journal Article
Refereed: Yes
Keywords: Chemotherapy, Multimodality therapy, Mesothelioma, Survival
DOI: 10.1016/j.lungcan.2016.07.023
ISSN: 0169-5002
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > ONCOLOGY AND CARCINOGENESIS (111200) > Chemotherapy (111205)
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2016 Elsevier Ireland Ltd.
Deposited On: 12 Sep 2016 23:37
Last Modified: 14 Sep 2016 00:34

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