For malignant pleural mesothelioma patients ineligible for surgery, treatment options are very limited. For the last ten years, the go to treatment has been chemotherapy utilizing pemetrexed and cisplatin, but that may be about to change due to promising new data from the French Cooperative Thoracic Intergroup (IFCT).
At the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting, IFCT presented the results of a MAPS study in which pemetrexed and cisplatin, the current standard of care for mesothelioma were supplemented with bevacizumab and according to IFCT, showed (significantly) longer overall survival.
The MAPS study was randomized with 225 patients receiving the standard pemetrexed and cisplatin, and 223 patients receiving the triplet therapy of bevacizumab, pemetrexed, and cisplatin. Both groups in the study received six cycles of treatment, with Bevacizumab administered at a dose of 15 mg on day 1 of each cycle. At the end of the six cycles, the patients receiving the triplet continued to receive bevacizumab alone until there was a recurrence of disease. 75% of participants in the study were male with an average age of 65 years, disease histology among participants was 80% epithelioid.
Overall survival for patients receiving bevacizumab was 18.8 months compared with those only receiving pemetrexed and cisplatin at 16.1 months. Patients receiving bevacizumab also experienced longer time before disease recurrence, 9.6 months compared to 7.5 months for those on pemetrexed and cisplatin alone.
Anna Nowak, PhD, of the Sir Charles Gairdner Hospital in Perth, Western Australia, who partook in a discussion of the study was more circumspect. "The results of the MAPS trial were eagerly awaited," she said, but she was cautious in endorsing it as a new standard of care, because it appeared that long-term OS (overall survival) may be an issue when one looked at the "tail end" of the OS curves.
Natasha Leighl, MD, from Princess Margaret Cancer Centre, Toronto, Canada, said that this data was "practice changing" for patients with mesothelioma, but noted that the drug is expensive.
"Its uptake may vary with geography particularly when the data are considered in the context of health economics and effectiveness," Dr. Nowak said. "Demand for a new standard of care will exist irrespective of the cost."
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