Relapse patterns and tailored treatment strategies for malignant pleural mesothelioma recurrence after multimodality therapy

Abstract

To date, there have been no established therapies for recurrent malignant pleural meso-thelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for re-lapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and Feb-ruary 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-re-currence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, p = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology (p = 0.026, HR0.491, IC95%0.263–0.916), local failure (p = 0.027, HR0.707, IC95%0.521–0.961), DFS ≥ 12 months (p = 0.006, HR0.298, IC95%0.137– 0.812) and post-recurrence medical treatment (p = 0.046, HR0.101, IC95%0.897–0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only re-lapse.