Pleural and Peritoneal Mesothelioma Combination Can Be Managed

A patient diagnosed with pleural and peritoneal mesothelioma today can survive well beyond expectations, provided personalized treatment can be found at a specialty center.

Research from the Columbia University Medical Center in New York City has shown that despite the poor prognosis typically accompanies this rare diagnosis, patients still can thrive.

“This is an understudied, and poorly understood, group of patients that often is just written off,” surgical oncologist Dr. Michael Kluger at Columbia told The Mesothelioma Center at Asbestos.com. “But we’ve shown a meaningful survival.”

Kluger, who specializes in peritoneal mesothelioma, is co-author of a recent, single-center study.

The cohort included 50 patients spanning 21 years who were treated for malignant mesothelioma in the thoracic (pleural) and abdominal (peritoneal) cavities at the New York Presbyterian Hospital/Columbia Medical Center.

Annals of Surgical Oncology published the study in its January 2020 issue.

First Time This Group Was Studied

This was the first study to broadly examine the outcomes of patients diagnosed with peritoneal and pleural mesothelioma, according to the authors.

“Mesothelioma, in either case, is often seen around the country as a disease that can’t be treated,” Kluger said. “And when in both places, it’s viewed as a double whammy with no chance of surviving. But this study showed otherwise.”

Study results included:

• Median overall survival of 33.9 months from initial intervention.
• One-, three- and five-year survival rates were 84%, 43% and 34.4%, respectively.
• Median survival of 33 months for those first diagnosed with pleural mesothelioma and 36 months for those with an initial diagnosis of peritoneal mesothelioma.

By comparison, the median survival period for all patients diagnosed with malignant mesothelioma is just eight months, according to the extensive Surveillance, Epidemiology, and End Results database that is used by the National Cancer Institute and includes the records of more than 18,500 patients.

Patients with single-site disease treated with a multimodality approach had an estimated median survival of six to 32 months for pleural mesothelioma, and 34 to 92 months for peritoneal mesothelioma.

“We were surprised by what we found in our study of patients here, but also pretty impressed,” Kluger said. “There were patients able to get treatment of both the chest and the abdominal cavity. These patients can be treated and not just palliated.”

Second Disease Site Often Develops Quickly

Patients who were treated only with palliative care were not included in the study.

Only those who received operative treatment of at least one cavity with intent of extending survival were used. Researchers also included epithelioid, sarcomatoid and biphasic subtypes of disease.

Among the patients in the study, 54% were diagnosed with second-cavity disease within the first year after the initial diagnosis.

The median time to second diagnosis for those patients was 4.1 months. And the median overall survival in that group was 26.6 months.

Peritoneal disease was identified first in 66% of the patients.

Approximately 3,000 patients are diagnosed with mesothelioma each year in the United States. An estimated two-thirds of them have the pleural type.

Survivors Provide Living Proof

The number of cases that include pleural and peritoneal disease is unknown, according to the study authors, but the presumption is that cases are extremely rare.

Although neither were part of this latest study, Randy Jarreau in Baton Rouge, Louisiana, and Tina Herford in Los Angeles continue to thrive. They provide inspiration for others struck by the two most common types of mesothelioma.

Jarreau, who was first diagnosed with peritoneal mesothelioma in 2012, has had aggressive surgery in the abdominal and thoracic cavities at the National Institutes of Health in Bethesda, Maryland, after enrolling in a clinical trial.

Herford was diagnosed first with pleural mesothelioma in 2016 and a year later with the peritoneal type. She underwent two extensive surgeries at the UCLA Comprehensive Cancer Center.

The study emphasized that the presence of disease in both places should not discourage patients from seeking multimodality treatment aimed at prolonging survival.

“The care has to be tailored to each individual patient,” Kluger said. “There is hope for these patients, but they need to seek care at a center that really knows how to treat both diseases.”

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