Real‐world outcomes for patients with pleural mesothelioma: A multisite retrospective cohort study

To evaluate the real‐world treatment patterns and outcomes for patients with pleural mesothelioma (PM) in the era of immunotherapy.This retrospective audit included patients with PM diagnosed within three tertiary referral centers in Queensland, Australia from January 2017 to July 2023. Patient and treatment characteristics and outcomes were recorded. Data was analyzed using descriptive statistics and the Kaplan‐Meier survival method.A total of 90 patients were included: 84% were male, the median age was 75 years (range 70–79) and 85% had baseline Eastern Group Cooperative Group of 0–1. Subtypes included 54% epithelioid, 17% biphasic, 12% sarcomatoid, and 17% unspecified/unknown. First‐line treatment was received by 57/90 patients (63%) and 33/90 patients (37%) received the best supportive care (BSC). Chemotherapy was most used (63%) overall, but first‐line immunotherapy was more commonly used since ipilimumab/nivolumab was reimbursed by the Australian Pharmaceutical Benefits Scheme in July 2021. After first‐line treatment, only 40% received second‐line treatment and 60% received BSC.12‐month overall survival (OS) and progression‐free survival for all patients were 53% (95% confidence interval [CI]: 43–65) and 25% (95% CI 15–40) respectively. 12‐month OS was 72%, 64%, and 29% for immunotherapy, chemotherapy, and BSC, respectively. There was no significant difference in survival between chemotherapy and immunotherapy (hazard ratio 1.28, 95% CI: 0.65–2.5, p = 0.5).In our unselected real‐world cohort, both chemotherapy and immunotherapy are active against PM, but the prognosis remains guarded. There remains a need for better treatment options, especially in the first‐line setting. Enrolment in clinical trials is crucial to improving outcomes in this debilitating disease.

评估免疫治疗时代胸膜间皮瘤（PM）患者的真实世界治疗模式和结果。这项回顾性审核纳入了2017年1月至2023年7月在澳大利亚昆士兰州三个三级转诊中心确诊的PM患者。记录患者和治疗特征以及结果。使用描述性统计和卡普兰 - 迈耶生存分析法对数据进行分析。 共纳入90例患者：84%为男性，中位年龄为75岁（范围70 - 79岁），85%的患者基线东部肿瘤协作组（Eastern Group Cooperative Group）评分为0 - 1分。亚型包括54%的上皮样型、17%的双相型、12%的肉瘤样型以及17%的未明确/未知型。90例患者中有57例（63%）接受了一线治疗，33例（37%）接受了最佳支持治疗（BSC）。总体而言，化疗使用最多（63%），但自2021年7月伊匹木单抗/纳武利尤单抗被澳大利亚药品福利计划报销以来，一线免疫治疗使用更为普遍。在一线治疗后，只有40%的患者接受了二线治疗，60%接受了BSC。 所有患者的12个月总生存率（OS）和无进展生存率分别为53%（95%置信区间[CI]：43 - 65）和25%（95%CI 15 - 40）。免疫治疗、化疗和BSC的12个月OS分别为72%、64%和29%。化疗和免疫治疗之间的生存率无显著差异（风险比1.28，95%CI：0.65 - 2.5，p = 0.5）。 在我们未经选择的真实世界队列中，化疗和免疫治疗对PM均有效，但预后仍不容乐观。仍然需要更好的治疗选择，特别是在一线治疗方面。参加临床试验对于改善这种使人衰弱的疾病的结果至关重要。