What are the survival rates for patients with epithelioid pleural mesothelioma after chemotherapy with cisplatin and pemetrexed followed by pleurectomy/decortication (P/D)?

Survival Data for Epithelioid Pleural Mesothelioma After Cisplatin-Pemetrexed Chemotherapy Followed by Pleurectomy/Decortication

Direct Answer to Your Question

For patients with epithelioid pleural mesothelioma treated with cisplatin-pemetrexed chemotherapy followed by pleurectomy/decortication (P/D), median survival ranges from 20.5 to 24.6 months, with 5-year survival rates reaching approximately 24-27% in carefully selected patients. 1

Worldwide Survival Data

Multimodality Treatment Outcomes (Chemotherapy + P/D)

Large retrospective analysis (1,365 patients, 1982-2012):

• Median survival for P/D: 20.5 months 1
• Patients with P/D plus adjuvant therapy: 19.8 months median survival 1
• For patients with all three favorable prognostic factors (age <70 years, epithelial histology, receipt of chemotherapy): 24.6 months median survival with P/D 1

Prospective Japanese multi-institutional study (2022):

• 18 patients achieved macroscopic complete resection after neoadjuvant cisplatin-pemetrexed followed by P/D 2
• 1-year overall survival: 95.0% 2
• 2-year overall survival: 70.0% 2
• Median overall survival: 3.45 years (41.4 months) 2
• No 30-day or 90-day treatment-related mortality 2

Belgian single-center study with EPP (2019) - for comparison:

• Patients completing full combined modality treatment (CMT) protocol with cisplatin-pemetrexed: 33.2 months median survival 3
• 5-year survival for those completing CMT: 24.2% 3
• For epithelioid type with negative lymph nodes (pN0): 27.0% 5-year disease-free survival 3

Chemotherapy Alone (Without Surgery) - Baseline Comparison

For context, chemotherapy-only outcomes:

• Cisplatin-pemetrexed alone: 12.1 months median survival 1
• Medical therapy alone (chemotherapy or best supportive care): 11.7 months median survival 1

Key Prognostic Factors That Influence Survival

Favorable prognostic factors associated with better outcomes:

• Age <70 years 1
• Epithelial histology (versus sarcomatoid or biphasic) 1, 4
• Receipt of chemotherapy 1
• Negative lymph nodes (pN0) after surgery 3
• Macroscopic complete resection 5

Patients with epithelioid histology specifically:

• Median survival: 17.9 to 28.2 months depending on completeness of resection 5
• Significantly better survival compared to sarcomatoid subtype (9.2 months) 5

Important Clinical Context

Surgery must be combined with systemic therapy:

• Surgery alone is insufficient; additional chemotherapy and/or radiation therapy should be administered 1
• Multimodality therapy shows median overall survival of 13 to 23.9 months in systematic reviews 1

Patient selection is critical:

• Only selected patients with early-stage disease, good performance status (≤2), and epithelioid histology should be considered for surgical cytoreduction 1
• Patients with minimal solid disease or only pleural effusion are ideal candidates, with median survival potentially reaching 48 months 1

Attrition rates matter:

• Intent-to-treat survival (all patients starting treatment) is lower than survival in those completing all planned therapy 1
• Not all patients who start chemotherapy will proceed to surgery or complete the full protocol 3, 2

Location-Specific Data

I cannot provide specific survival data for your particular location as no location-specific evidence was provided in the available studies. The worldwide data presented above comes from multi-institutional studies across Europe, Japan, and North America 1, 3, 2.

Common Pitfalls to Avoid

Do not extrapolate these survival figures to:

• Patients with sarcomatoid or biphasic histology (significantly worse prognosis) 4, 5
• Patients with performance status ≥3 (should receive palliative care only) 1
• Patients with advanced stage disease or bulky tumors 1
• Elderly patients >75 years or those with significant comorbidities 1

Remember that:

• These survival figures represent highly selected surgical candidates, not all patients with epithelioid mesothelioma 1
• Surgical decisions should involve multidisciplinary input from thoracic surgeons, pulmonologists, and medical/radiation oncologists 1