Researchers at Duke University’s Medical Center have found neoadjuvant chemotherapy, commonly applied prior to aggressive surgery, does not provide survival benefits for those plagued by pleural mesothelioma cancer. This study is important as it bolstered the emerging sentiment of mesothelioma experts that the unison of chemotherapy drugs such as pemetrexed and cisplatin has the potential to prove to be a much more effective treatment following surgery rather than prior to the surgery. Let’s take a closer look at how the study was conducted and how it is likely to shape mesothelioma treatment in the future.
Additional Details About the Study
Dr. David Harpole, a respected thoracic surgical specialist at Duke University’s Cancer Center, insists the study referenced above provides even more evidence in support of what the mesothelioma medical community has observed in recent years: neoadjuvant chemotherapy is not as effective of a treatment as initially assumed. The study results are likely to significantly alter the thought processes, strategies and approaches of those who work in the medical oncology community. The authors of the study insist it is the most expansive retrospective analysis designed to compare the outcomes of these two patient cohorts.
The Duke study was formally published this past February in the Journal of the National Cancer Institute. The study’s lead author was Dr. Soraya L. Voigt. The forementioned Dr. David Harpole and Dr. Vignesh Raman were co-authors of the study. The purpose of the study was to determine if patients actually received meaningful benefit from the neoadjuvant chemotherapy regimen. Most importantly, those who spearheaded the study desired to know if neoadjuvant chemotherapy actually boosted the rate of survival.
A Closer Look at the Study’s Results
Sadly, the Duke University study revealed providing mesothelioma patients with neoadjuvant chemotherapy did not enhance their overall survival rate. The study determined there are no chemotherapy survival benefits prior to surgery. The purpose of using neoadjuvant chemotherapy for the treatment of mesothelioma is that it was thought this treatment likely decreased tumor burdens, helping surgery prove that much more effective, possibly qualifying patients for surgery who otherwise would not have been suitable candidates for such a procedure.
The Duke University study was retrospective in that it compared the efficacy of patients with prompt resection without holding off for chemotherapy treatment. Two specific patient cohorts were analyzed for the study: Nearly 2,000 patients in the National Cancer Database from ’04 to ’15 and 250+ Duke University patients from ’95 to ’17. The study determined the survival rates in each cohort were similar yet there was a heightened chance for post-resection death for patients who were treated with neoadjuvant chemotherapy.
The National Cancer Database provided a propensity matched group of nearly 270 patient pairs, showing a post-resection survival length of 19 months when immediate resection was applied. However, survival length was a mere 16 months for patients who first underwent chemotherapy. It is particularly interesting to note there were no statistically meaningful variances in terms of post-resection survival in the groups within the Duke cohorts’ propensity matching that analyzed 60 patient pairs. There was a dramatic boost of risk for post-resection death in each cohort within the neoadjuvant chemotherapy group yet there was not an overarching mortality increase.
Does the Study Indicate Neoadjuvant Chemotherapy for Mesothelioma Should Cease?
Take a close look at the data detailed above and you might reach the conclusion that the study’s authors believe neoadjuvant chemotherapy should come to an end. However, the data revealed in the study is not strong enough to completely cease the use of neoadjuvant chemotherapy for mesothelioma patients. This form of therapy is still quite effective for certain patients. However, doctors should be more selective when determining which patients are most likely to benefit from the therapy.
In particular, those involved in clinical trials in which chemotherapy is being investigated with immunotherapy prior to resection have the most potential to benefit from this treatment regimen. The key takeaway from the study is neoadjuvant chemotherapy’s oncologic value is likely to be hotly-debated in medical circles for the foreseeable future. There is a good chance this form of therapy will be significantly scaled down as time progresses.
Does the National Cancer Care Network Provide Advice for the use of Neoadjuvant Chemotherapy?
At the moment, the National Cancer Care Network does not provide any sort of overarching guidelines for the use of neoadjuvant chemotherapy for mesothelioma sufferers who are candidates for surgery. The logic in continuing to use this form of chemotherapy is rooted in prior studies that show the reduced mortality rates for patients who were provided with the therapy yet were not candidates for surgery. At the moment, there are no upcoming clinical trials to compare neoadjuvant chemotherapy use with immediate resection.
A Strategic Pivot for Mesothelioma Treatment?
It is quite possible the results of the Duke University study will significantly alter the manner in which mesothelioma patients are treated. Prior to the study, there was a consensus throughout the medical community that the use of neoadjuvant chemotherapy had the potential to cause remission, causing tumor downstaging and boosting the odds of full macroscopic resection. The Duke University study proved the exact opposite, showing neoadjuvant chemotherapy does not spur a meaningful boost in mesothelioma patient survival rates.
Prior studies indicated 33% of patients provided with neoadjuvant therapy had a subsequent radiographic response. The Duke University study showed a mere 20% of such patients displayed a radiographic response to neoadjuvant therapy. Those who do not respond are that much more likely to be saddled with a progression of the disease as surgery is delayed to complete the course of chemotherapy treatment.
Furthermore, it is important to note plenty of patients who enjoy a disease reduction stemming from neoadjuvant chemotherapy will also endure harsh side effects that reduce overarching fitness and ultimately make a timely and complete recovery from surgery that much more challenging. Previous studies showed upwards of 75% of patients provided with neoadjuvant chemotherapy were able to move onward with surgery.
Progress in the Fight Against Mesothelioma is Being Made
The conclusion of the study is not that chemotherapy provides poor outcomes for mesothelioma surgical patients. Rather, the findings show it is better to use chemotherapy with a diminutive amount of disease following the surgery. In the end, it can be said without a hint of doubt that the Duke University study is a meaningful step toward developing a mesothelioma cure. This study will likely be referenced by medical professionals for years and decades to come, possibly shaping treatment approaches and ultimately helping mesothelioma patients reach maximum medical improvement as soon as possible.
If you or a loved one has mesothelioma or has been exposed to asbestos, please find an experienced attorney today!