The South West Area Mesothelioma and Pemetrexed trial; a multicentre prospective observational study evaluating novel markers of chemotherapy response and prognostication: The South West Area Mesothelioma and Pemetrexed trial

C E Hooper, I D Lyburn, J Searle, M Darby, T Hall, D Hall, A Morley, P White, N M Rahman, E De Winton, A Clive, V Masani, D T Arnold, A Dangoor, S Guglani, P Jankowska, S A Lowndes, J E Harvey, J P Braybrooke, N A Maskell

Research output: Contribution to journalArticle (Academic Journal)peer-review

29 Citations (Scopus)

Abstract

BACKGROUND: Robust markers that predict prognosis and detect early treatment response in malignant pleural mesothelioma (MPM) would enhance patient care.

METHODS: Consecutive patients with MPM who were considered fit for first-line chemotherapy were prospectively recruited. Patients of similar performance status opting for best supportive care were included as a comparator group. Baseline and interval CT, PET-CT and serum markers (mesothelin, fibulin-3 and neutrophil-lymphocyte ratio (NLR)) were obtained, and patients followed up for a minimum 12 months.

FINDINGS: Seventy-three patients were recruited (58 chemotherapy/15 comparator arm). Baseline TGV (total glycolytic volume on PET-CT) was an independent predictor of worse overall survival (OS) (P=0.001). Change in interval TGV(baseline/after two cycles of chemotherapy) did not predict OS or chemotherapy response on CT. Baseline NLR<4 was an independent predictor of better OS (median survival 453 (IQR 272-576) days vs NLR⩾4, 257 (IQR 147-490), P=0.002). Although baseline serum mesothelin did not predict OS, a falling level at 8 weeks significantly predicted longer time to progression (TTP) (P<0.001).

INTERPRETATION: Neutrophil-lymphocyte ratio and baseline TGV predict prognosis in malignant pleural mesothelioma (MPM), but PET-CT is unhelpful in monitoring chemotherapy response. Serum mesothelin is a useful early treatment response marker when measured serially during chemotherapy and may have a role in evaluating patients' treatment response.

Original languageEnglish
Pages (from-to)1175-82
Number of pages8
JournalBritish Journal of Cancer
Volume112
Issue number7
DOIs
Publication statusPublished - 31 Mar 2015

Structured keywords

  • Memory

Keywords

  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols
  • Biomarkers, Tumor
  • Carboplatin
  • Cisplatin
  • Cohort Studies
  • Female
  • Glutamates
  • Guanine
  • Humans
  • Lung Neoplasms
  • Lymphocytes
  • Male
  • Mesothelioma
  • Multimodal Imaging
  • Neutrophils
  • Pemetrexed
  • Positron-Emission Tomography
  • Prognosis
  • Prospective Studies
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Clinical Trial
  • Journal Article
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

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