Neoadjuvant chemotherapy is chemotherapy treatment given to cancer patients before they have surgery. For mesothelioma patients, the surgery is often aggressive, in an effort to remove all cancer.
A study recently conducted by Duke University Medical Center has looked at the survival benefit for neoadjuvant chemotherapy as treatment for pleural mesothelioma. The findings suggest that there may not be any survival benefit to patients.
The theory behind neoadjuvant chemotherapy is that it reduces the size of the tumour and therefore reduces the amount of tumour that needs to be removed. This can mean patients who were not eligible for surgery prior to neoadjuvant chemotherapy may become eligible if their tumour shrinks.
It was a retrospective study that compared patients who had neoadjuvant chemotherapy with those who had resection surgery without chemotherapy first.
The study consisted of 257 patients from Duke Medical Center from 1995 to 2017 and 1,949 patients from the National Cancer Database from 2004 to 2015.
It was found that overall, there were similar survival rates, however, there was an increased risk in post-resection mortality for patients who underwent neoadjuvant chemotherapy.
The median post-resection survival for patients who had chemotherapy prior to surgery was 16 months, compared to 19 months for patients who had surgery first.
“The data isn’t strong enough”
Dr David Harpole, a thoracic surgeon at Dukes, says there isn’t enough data but neoadjuvant chemotherapy does still have its uses, “The data isn’t strong enough to say it [neoadjuvant chemotherapy] shouldn’t be done anymore. There still is a role for it for selected patients, and especially for those on clinical trials investigating chemotherapy with immunotherapy before resection.”
Other issues with neoadjuvant chemotherapy
Along with the results in this study, there are other issues that should be addressed when looking at chemotherapy prior to surgery.
Chemotherapy can have some nasty side effects, such as nausea, fatigue and anaemia. These can affect the patient’s overall fitness and can cause a patient’s health to deteriorate to the point where are no longer strong enough to undergo surgery. A previous study has found that only 70 to 75% of patients who have neoadjuvant chemotherapy are able to have surgery.
There is a growing belief that chemotherapy for mesothelioma patients may be more effective after resection surgery than before.
Dr Harpole stated, “We’re not saying the chemotherapy regimen is bad for surgical patients – it isn’t – but maybe it’s better when used with small amount of disease after surgery. This was a positive step in our goal of getting closer to coming up with a real cure for mesothelioma.”
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Voigt, S. et al. (2020, February 3). The Role of Neoadjuvant Chemotherapy in Patients With Resectable Malignant Pleural Mesothelioma — An Institutional and National Analysis. Retrieved from: https://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djaa002/5721361?redirectedFrom=fulltext