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Altan, Mehmet

Deboever, Nathaniel

Haymaker, Cara

Hofstetter, Wayne

Lee, Percy P

McGrail, Daniel

Mehran, Reza J

Olivia, Jacqueline

Parra, Edwin

Rajaram, Ravi

Rice, David C

Sepesi, Boris

Tomczak, Katarzyna

Tsao, Anne S

Vaporciyan, Ara

Weissferdt, Annikka

Zhang, Jianjun

Zhou, Nicolas

English

OpenWorks @ MD Anderson

Clinical and Environment Factors Impacting Malignant Pleural Mesothelioma PrognosisNathaniel Deboever1, Daniel J. McGrail2, Nicolas Zhou1, Mehmet Altan3, Jacqueline L. Olivia4, Edwin Parra4, Jianjun Zhang5, Percy P. Lee6, Ravi Rajaram1, Wayne L. Hofstetter1, Ara A. Vaporciyan1, Reza J. Mehran1, David C. Rice1, Katarzyna Tomczak4, Annikka Weissferdt5, Anne S. Tsao3, Cara L. Haymaker4, Boris Sepesi11Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TXDepartments of 2Bioinformatics and Computational Biology, 3Thoracic/Head and Neck Medical Oncology, 4Translational Molecular Pathology, 5Pathology, 6Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston TXIntroduction• Malignant Pleural Mesothelioma (MPM) is associated with poor prognosis• Current management practice involves use of neoadjuvant systemic therapy• Surgical option includes extrapleural pneumonectomy and pleurectomy with decortication• Patients necessitate significant recovery following either proceduresObjectivesTo identify variables associated with favorable and unfavorable outcomes in the multimodal management of MPM, inclusive of macroscopic complete resectionMethods• Retrospective review of single center prospectively maintained database• Patients who underwent macroscopic complete resection, and received systemic therapy• Clinicopathologic and environmental risk factors included• Change in tumor thickness (Delta TT) characterized as difference in thickness using modified RECIST criteria, from pre- to post-systemic therapy measurement• Neutrophil to Lymphocyte Ratio (NLR) based upon post-neoadjuvant blood samples.Results• 103 patients met inclusion criteria• Clinicopathologic Characteristics (Table)• Change in Tumor Thickness (Waterfall Plot)• Multivariable Cox Regression Analysis (Forest Plot)• Ever Smoker (OR = 1.9, 95CI: 1.2 to 2.9)• Asbestos Exposure (OR=1.5, 95CI: 0.9-2.5)• NLR (OR=1.5, 95CI: 1.0-2.4)• Delta TT (OR=2.5, 95CI: 1.6-4.0) • Response to Neoadjuvant Therapy (Spaghetti Plot)• Kaplan-Meier Analysis Median Survival: • Less than 3 risk factors (RF) present: 33.2 months• 3 or more RF present: 10.22 monthsDiscussion• In context of Checkmate743 results, patients with 3 or more RF might not benefit from surgery versus first line combination immunotherapy (nivolumab + ipilimumab)• Multidisciplinary approach warranted to provide meaningful outcomes based on patient wishes• Combination of four factors is useful metric to inform surgical decision making• Threshold of presence of 3 factors appears to lead to significant stratification of prognosis in resectable MPMDisclosures of Presenting Author: NoneContact Information: ndeboever@mdanderson.orgTable: Clinicopathologic Characteristics Waterfall Plot representing radiomic response to systemic therapyForest Plot highlighting results of cox regression, with outcome overall survivalSpaghetti Plot representing temporal changes in tumor thickness from systemic therapyKaplan-Meier Analysis highlighting median overall survival stratified by number of risk factors

Clinical and Environment Factors Impacting Malignant Pleural Mesothelioma Prognosis

https://openworks.mdanderson.org/cgi/viewcontent.cgi?article=1012&context=leading-edge

Clinical and Environment Factors Impacting Malignant Pleural Mesothelioma Prognosis

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