Disparities in Compliance with National Guidelines for the Treatment of Malignant Pleural Mesothelioma

Publication date: Available online 18 April 2019Source: The Annals of Thoracic SurgeryAuthor(s): Fernando Espinoza-Mercado, Jerald D. Borgella, David Berz, Rodrigo F. Alban, Ariella Sarkissian, Taryne A. Imai, Harmik J. SoukiasianAbstractBackgroundCurrent guidelines support cancer-directed surgery, chemotherapy or active surveillance for clinical stages 1 to 3 of epithelial Malignant Pleural Mesothelioma (MPM). Definitive chemotherapy is recommended for sarcomatoid/biphasic histologies. Our objective is to assess compliance with recommendations, measuring their impact on overall survival (OS).MethodsThe National Cancer Database participant user file (2004-2014) was queried for patients diagnosed with MPM clinical stages 1 to 3. Multivariable logistic regression model identified factors independently associated with guideline compliance. Kaplan-Meier analysis and Cox proportional hazards were used for OS comparison with histologic subgroup analysis.ResultsA total of 3,419 patients with clinical stages 1 to 3 met criteria for analysis and were comprised of epithelial (68.5%), sarcomatoid (17.2%), and biphasic subtypes (14.3%). Cancer-directed surgery was significantly underutilized in epithelial MPM with 29.3% having no treatment. On multivariable analysis, insurance status and facility type were the strongest predictors of guideline compliance. High-volume hospitals were the most compliant with guidelines (odds ratio [OR] 3.58, 95% CI 2.34-5.49, p
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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The Princess Margaret Cancer Center in Toronto has moved from SMART to SMARTER with the recent launch of its latest clinical trial for pleural mesothelioma patients. SMARTER is the acronym for Surgery for Mesothelioma After Radiation Therapy using Extensive pleural Resection, which also describes the latest clinical trial. The phase I clinical trial is an unconventional approach to treatment of mesothelioma: Find the maximum tolerated dosage of hypofractionated radiation to stimulate the immune system before aggressive surgery. It comes on the heels of the SMART protocol, which stands for Surgery for Mesothelioma After Rad...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
Too many patients with pleural mesothelioma are going without treatment recommended by National Comprehensive Cancer Network guidelines, according to a recent study at Cedars-Sinai Medical Center in Los Angeles. Valuable survival time is being lost. The Annals of Thoracic Surgery published the study that looked at disparities in compliance with national treatment guidelines and their impact on overall survival. The National Comprehensive Cancer Network, along with the American Society of Clinical Oncology, recommends multimodal therapy — surgery, chemotherapy and possibly radiation therapy — for mesothelioma pa...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
In this study we tested the clinoptilolite, chabazite, and natrolite ability to be loaded by antitumor ribonuclease binase and the cytotoxicity of the obtained complexes. We found the optimal conditions for binase loading into zeolites and established the dynamic of its release. Cytotoxic effects of zeolite-binase complexes toward colorectal cancer Caco2 cells were characterized after 24 and 48 h of incubation with cells using MTT-test. Zeolites were toxic by itselfs and reduced cells viability by 30% (clinoptilolite), 40% (chabazite), and 70% (natrolite) after 48 h of incubation. Binase complexes with clinoptilolite as we...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusions This review describes how leukocyte-heparanase can be a double-edged sword in tumor progression; it can enhance tumor immune surveillance and tumor cell clearance, but also promote tumor survival and growth. We also discuss the potential of using heparanase in leukocyte therapies against tumors, and the effects of heparanase inhibitors on tumor progression and immunity. We are just beginning to understand the influence of heparanase on a pro/anti-tumor immune response, and there are still many questions to answer. How do the pro/anti-tumorigenic effects of heparanase differ across different cancer types? Does...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Abstract BACKGROUND: Current guidelines support cancer-directed surgery, chemotherapy or active surveillance for clinical stages 1 to 3 of epithelial Malignant Pleural Mesothelioma (MPM). Definitive chemotherapy is recommended for sarcomatoid/biphasic histologies. Our objective is to assess compliance with recommendations, measuring their impact on overall survival (OS). METHODS: The National Cancer Database participant user file (2004-2014) was queried for patients diagnosed with MPM clinical stages 1 to 3. Multivariable logistic regression model identified factors independently associated with guideline com...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Joe Abdo1, Christopher S. Wichman2, Nicholas E. Dietz1,3, Pawel Ciborowski4, John Fleegel1, Sumeet K. Mittal1,5 and Devendra K. Agrawal1* 1Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE, United States 2Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States 3Department of Pathology, CHI Health Creighton University Medical Center, College of Medicine, Omaha, NE, United States 4Department of Pharmacology, University of Nebraska Medical Center, Omaha, NE, United States 5Norton Thoracic Institute, St....
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Survival time improved significantly for peritoneal mesothelioma patients in Finland who underwent a combination of surgery and chemotherapy, according to a recently released study. The five-year survival rate was 66 percent. The median survival was 62 months. According to a smaller, previous study in Finland, the median survival without treatment was just four months after diagnosis. “Despite these advances in treatment…the majority of patients with malignant peritoneal mesothelioma receive only palliative care of systemic chemotherapy, leaving many eligible patients without the benefit of this more invasive...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
A team of researchers at the Hyogo College of Medicine in Nishinomiya, Japan, studied the outcomes for pleural mesothelioma patients who received surgery at their facility between 2004 and 2016. The results: More aggressive surgery did not help mesothelioma patients live longer. “We showed that introducing less-invasive surgical techniques could decrease surgical risks without compromising survival,” the researchers wrote in their study, published in January in Seminars in Thoracic and Cardiovascular Surgery. “Surgery that is less invasive than conventional extrapleural pneumonectomy could achieve lower ...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
chel L O’Donnell Dysfunctional homologous recombination DNA repair (HRR), frequently due to BRCA mutations, is a determinant of sensitivity to platinum chemotherapy and poly(ADP-ribose) polymerase inhibitors (PARPi). In cultures of ovarian cancer cells, we have previously shown that HRR function, based upon RAD51 foci quantification, correlated with growth inhibition ex vivo induced by rucaparib (a PARPi) and 12-month survival following platinum chemotherapy. The aim of this study was to determine the feasibility of measuring HRR dysfunction (HRD) in other tumours, in order to estimate the frequency and hence wid...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Intraoperative photodynamic therapy combined with novel proton radiation improved survival time significantly for recent patients with advanced-stage pleural mesothelioma. The study — the first to measure the impact of this combination — involved 10 consecutive patients treated at the University of Pennsylvania’s Abramson Cancer Center. The treatment regimen resulted in a 90 percent, two-year disease control rate and an impressive 30.3-month median overall survival from the time of diagnosis. All 10 patients were diagnosed before treatment began with stage 3 or stage 4 disease, which typically results in ...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
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