Mesothelioma: Evans WK

Ellis P, Davies AM, Evans WK, Haynes AE, Lloyd NS, Anonymous00155. · McMaster University at Hamilton Health Sciences and Juravinski Cancer Centre, Hamilton, Ontario, Canada. · J Thorac Oncol. · Pubmed #17409924 No free full text.

Abstract: BACKGROUND: This clinical practice guideline, based on a systematic review, was developed to determine which chemotherapeutic agents (or combinations of agents) show the highest response rates, improved survival, quality of life, or symptom control in patients with advanced malignant pleural mesothelioma. METHODS: A thorough systematic search of the literature was conducted for published articles and conference proceedings for applicable abstracts. Relevant trials, published as articles and abstracts, were selected and assessed. External feedback was obtained from Ontario clinicians, and the guideline was approved by the provincial Lung Cancer Disease Site Group. RESULTS: One hundred nineteen studies were eligible, including eight randomized trials and 111 phase II trials. The pooled response rates from phase II trials suggest that response rates with combination chemotherapy are higher than with single agents. Data from the largest randomized controlled trial demonstrated that chemotherapy with cisplatin and pemetrexed significantly improves response rates (41% versus 17%, p < 0.001), time to progression (5.7 months versus 3.9 months, p = 0.001), and overall survival (median, 12.1 months versus 9.3 months, hazard ratio = 0.77, p = 0.020) in comparison to single-agent cisplatin. A second trial demonstrated cisplatin and raltitrexed significantly improved median survival compared to single-agent cisplatin (11.4 months versus 8.8 months; hazard ratio = 0.76, p = 0.0483). Overall response rate (24% versus 14%, p = 0.056) was greater in the combination treatment arm, but this difference was not statistically significant. CONCLUSIONS: There is good evidence to recommend chemotherapy with pemetrexed and cisplatin for adult patients with symptomatic advanced malignant pleural mesothelioma. Such treatment should be administered with supplementation of vitamin B12 and folic acid. If pemetrexed is not available, cisplatin plus raltitrexed is a reasonable alternative.

Ung YC, Yu E, Falkson C, Haynes AE, Stys-Norman D, Evans WK, Anonymous00279. · Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON, Canada. · Radiother Oncol. · Pubmed #16820238 No free full text.

Abstract: INTRODUCTION: Radiation therapy may offer patients presenting with malignant pleural mesothelioma (MPM) symptom palliation and improvements in quality of life. This systematic review will address the role of radiation therapy in the management of MPM. METHODS: A thorough systematic search of the literature was conducted for published articles and conference proceedings for applicable abstracts. Relevant trials were selected and assessed. RESULTS: Three small randomized controlled trials compared prophylactic external beam radiation therapy to no radiation therapy for patients with thoracic tracts caused by drainage tubes or diagnostic procedures. None of those trials reported any serious adverse effects. A pooled analysis found no significant reduction in the frequency of procedure tract metastases. Four non-comparative studies have shown that hemithoracic irradiation alone resulted in significant toxicity, including radiation-induced pulmonary fibrosis, radiation pneumonitis, and bronchopleural fistula, without any survival benefit. Few of the identified studies reported on symptom control, and no studies included formal measures of quality of life. CONCLUSION: There is limited evidence for the role of radiotherapy in the management of patients with MPM. Future studies including radiotherapy for the treatment of such patients should include formal measures of quality of life and symptom control.

Maziak DE, Gagliardi A, Haynes AE, Mackay JA, Evans WK, Anonymous00370. · University of Ottawa, Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ont., Canada K1H 8L6. · Lung Cancer. · Pubmed #15829316 No free full text.

Abstract: An evidence summary was developed for the surgical management of adult patients with diffuse or localized malignant pleural mesothelioma. This evidence summary is based on a systematic search and review of the literature published between 1985 and February 2004. Relevant studies were identified, according to pre-determined criteria by the authors and methodologists. No randomized controlled trials comparing pleurectomy (PL) with extrapleural pneumonectomy (EPP) or comparing surgery with an alternative treatment were identified. Four comparative studies, seven non-comparative prospective studies, and 16 retrospective case series were identified that looked at PL, or EPP, or PL and EPP. Trial results were not pooled due to the heterogeneity of the treatments in the trials and the fact that no trials were randomized and none were designed to directly compare different treatments. External feedback was obtained from Ontario clinicians, and the provincial Lung Cancer Disease Site Group approved the review. CONCLUSIONS: The role of surgery in the management of malignant pleural mesothelioma cannot be precisely defined as the lack of randomized controlled clinical trials makes it impossible to determine whether the use of EPP or PL improves survival or effectively palliates the symptoms of the disease. Future studies of the role of surgery in the treatment of mesothelioma should include evaluations of quality of life.

Evans WK, Graham ID, Cameron D, Mackay JA, Brouwers M. · Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada. · J Thorac Oncol. · Pubmed #17409821 No free full text.

Abstract: PURPOSE: Practitioner feedback (PF) surveys are sent to practitioners who care for lung cancer patients as each new practice guideline is completed. In this study, the PF was reviewed to assess the frequency of response to the surveys, the respondents' characteristics, the nature of the feedback, and the intention to adopt the guideline in practice. METHODS: Fourteen practice guidelines (PGs) were sent to Ontario practitioners treating lung cancer, and feedback on the PGs was obtained through either an eight- or 21-item survey. RESULTS: Between 1995 and 2002, 1198 surveys were sent to 223 practitioners. The overall response rate was 58.9% but varied by specialty (radiation and medical oncologists, 67%; thoracic surgeons, 46%; respirologists, 38%), by location of practice (cancer center, 65%; community-based practice, 55%), by geographic region of the province (highest, 72%; lowest, 42%), and by PG topic (chemotherapy, 60%; radiotherapy, 63%; combined modality therapy, 52%). The response rate to the PF surveys did not decline over time. Eighty-six percent of respondents agreed with the lung cancer guidelines and indicated that they were likely or very likely to use the PGs in their practice. CONCLUSION: The results suggest that practitioners view the guideline development process as credible and useful to guide practice. Whether the stated intention to use the guidelines will actually translate into practice requires further study.