Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Lorenzo Spaggiari
Division of Thoracic Surgery, European Institute of Oncology, Milan/Italy
Background: Extrapleural pneumonectomy (EPP) with resection of
pericardium and diaphragm offers acceptable therapeutic results in
patients with mesothelioma. We analyzed efficacy of biological bovine
pericardial patch (BPP) versus artificial materials (Marlex/Goretex, Vicryl)
for diaphragmatic and pericardial reconstruction after EPP. Methods: We
reviewed 61 patients operated on for EPP after induction chemotherapy
(01/2013-05/2015). We distinguished two groups: Group 1, in which BPP
12x25 cm patch was used, and Group 2, in which artificial materials were
used. Technically, diaphragmatic patch was sewn circumferentially to
diaphragmatic remnant posteriorly, chest wall anteriorly, and hiatal
musculature medially by separated stitches. Pericardial patch was sewn
circumferentially to pericardial remnant by separated stitches. Results: Group
1, 27 patients (44.3%), right side in 14 (51.8%) and left in 13 (48.2%): BPP was
used for pericardium and diaphragm in 21, only pericardium in 4, and only
diaphragm in 2. Group 2, 34 patients (53.7%), right in 15 (44.1%) and left in
19 (55.9%): Marlex/Goretex for diaphragm and Vicryl for pericardium in 28,
Goretex for diaphragm and Vicryl for pericardium in 2, only Goretex or Vicryl
for both in 1 and 3 patients, respectively. In Group 1, a single BPP was used for
pericardial and double patch for diaphragm. Two patients (7.4%) in Group 1
and 2 (5.9%) in Group 2 (p=0.56), all on the left side, had early dehiscence of
diaphragmatic prosthesis requiring re-intervention. No early complication
for pericardial patch. At follow-up (Group 1: median 14.7 mo., range 0-72;
Group 2, median 14.2 mo., range 0-76), no late complications were observed
for pericardial/diaphragmatic prostheses. Conclusion: Reconstruction of
pericardium and diaphragm using BPP, is safe, easy, and may be considered a
viable alternative to synthetic materials. Attention should be used in fixing
the BPP on the left side (costo-phrenic angle) to avoid BPP dehiscence and
visceral herniation.
Keywords: Mesothelioma, Surgery
POSTER SESSION 3 – P3.03: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC
MESOTHELIOMA CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.03-060 CHARACTERISTICS AND LONG TERM OUTCOMES OF
ADVANCED PLEURAL MESOTHELIOMA IN LATIN AMERICA (MESO-
CLICAP)
Oscar Arrieta 1 , Andrés Cardona 2 , Luis Corrales 3 , George Oblitas 4 , Leonardo
Rojas 5 , Ludwing Bacon 6 , Claudio Martin 7 , Mauricio Cuello 8 , Luis Mas 9 , Beatriz
Wills 10 , Carlos Vargas 2 , Hernan Carranza 2 , Jorge Otero 2 , Maria Perez 11 , Lisde
González 4 , Luis Chirinos 12 , Rafael Rosell 13
1 Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto
Nacional de Cancerologia, Mexico City/Mexico, 2 Medical Oncology, Clinical
and Traslational Oncology Group, Institute of Oncology, Clínica Del Country,
Bogota/Colombia, 3 Clinical Oncology Department, Hospital San Juan de Dios
(San José, Costa Rica), San Jose/Costa Rica, 4 Hospital Oncológico Luis Razetti,
Caracas, Venezuela, Caracas/Venezuela, 5 Centro Javeriano de Oncología, Hospital
Universitario San Ignacio, Bogotá/Colombia, 6 Oncology Department, Hospital
Roberto Calderón, Managua, Nicaragua, Managua/Nicaragua, 7 Department of
Clinical Oncology, Instituto Alexander Fleming, Buenos Aires/Argentina, 8 Medical
Oncology Department, Udelar (Montevideo, Uruguay), Montevideo/Uruguay,
9 Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima/Peru,
10 Internal Medicine Department, Johns Hopkins Hospital, Baltimore, Maryland/
United States of America, 11 Medical Oncology, Arsuve, Caracas, Venezuela, Caracas/
Venezuela, 12 Clínica de Prevención Del Cáncer, Caracas, Venezuela, Caracas/
Venezuela, 13 Hospital Germans Trias I Pujol, Catalan Institute of Oncology,
Barcelona/Spain
Background: Malignant pleural mesothelioma (MPM) is an aggressive tumor,
usually associated with a poor prognosis. MPM is a heterogeneous disease
often associated with different clinical courses. Palliative platinum-based
chemotherapy may help to improve symptoms and prolong life. Methods:
The MeSO-CLICaP registry identified 124 patients with advanced MPM from
5 Latin American countries diagnosed and treated between January 2008
and March 2016. Data collected included age, gender, asbestos exposure,
presenting signs/symptoms, performance status, histology, stage, treatment
modalities including chemotherapy, and date of death or last follow-up.
Outcomes like progression free survival (PFS), overall survival (OS) and
response rate (ORR) were recorded. Cox model was applied to determine
variables associated with survival. Results: median age was 59.5 years (range
33-84), 72 (58%) were men, 69% were current or former smokers and 37
patients (30%) had previous exposure to asbestos. Ninety-six patients (77%)
had a baseline ECOG 0-1, 102 (82%) were epithelioid tumors, 47 (38%) and 77
(62%) cases had stage III or IV MPM. Only 20% (n=25) underwent pleurectomy,
28% (n=35) received radiotherapy and 123 patients received platinum-based
chemotherapy in first line (plus Pem 68/54% and Gem 55/44%). ORR to first
line chemotherapy was 48% (CR 3.2%/PR 43%), PFS was 10.5 months (95%CI
8.2-12.8) and 47 patients had Pem maintenance (mean number of cycles
4.4+/-3). Median OS was 25.3 months (95%CI 22.3-28.3) and according to a
univariate analysis, stage (p=0.03), histology (p=0.005), and Pem manteinance
(p=0.014) were associated with better OS. Multivariate analysis found that
stage (p=0.002), histology (p=0.021), smoking history (p=0.001) and Pem
manteinance (p=0.002) were independent prognostic factors. Conclusion: Our
study identifies factors associated with a clinical benefit from chemotherapy
among Hispanic patients with advanced MPM, and emphasizes the impact of
histology and clinical benefit of chemotherapy on outcomes.
Keywords: Advanced pleural mesothelioma, Latin America, Long term
outcomes, MeSo-CLICaP
POSTER SESSION 3 – P3.03: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC
MESOTHELIOMA CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.03-061 BURDEN OF DISEASE AND MANAGMENT OF
MESOTHELIOMA IN FRANCE: A NATIONAL COHORT ANALYSIS
Jean Baptiste Assié 1 , Pascal Andujar 2 , Isabelle Monnet 1 , Charlene Tournier 3 ,
Cecile Blein 3 , Alexandre Vainchtock 3 , Arnaud Scherpereel 4 , Jean Claude
Pairon 2 , Christos Chouaid 1
1 Grc Oncoest Creteil, Creteil/France, 2 Inserm U955, Ist, Creteil/France, 3 Heva, Lyon/
France, 4 Pulmonary and Thoracic Oncology, Hospital of the University (CHRU) of
Lille, Lille/France
Background: Malignant pleural mesothelioma (MPM) is an uncommon cancer
with poor survival. The aim of this study was to determine the burden of
MPM disease in France and analyze associations between socio-economic
deprivation, population density, management and outcomes of MPM.
Methods: We used a national hospital data base (PMSI-MCO) to extracted
MPM incidents patients of years 2011 and 2012 (ICD-10 codes C45.0 and C54.9
as principal/related or significantly associated diagnosis (PD,RD, SAD) in
2011 and 2012, without MPM codes or C34/C38.4 codes as PD/RD/SAD since
2006). Patients were followed for two years after the initial diagnosis. Cox
models were used to analysis one and two-years survival according to sex, age,
comorbidities, management, a population density index (PDI) and a social
deprivation index (SDI) based on census data aggregated at the municipalities
level. Results: 1890 patients were included on the analysis (men: 76%, age:
73.6 ± 10 years, significant comorbidities: 84%). Patients lived in urban zones
in 57% cases and in hight deprivated areas in 53%. Only 1% had a curative
surgical procedure; 65% received at leat one dose of chemotherapy (72% at
least one administration of chemotherapy with pemetrexed, 28% at least
one administration with pemetrexed - bevacizumab); 42% and 20% of the
patient received chemotherapy on the last three and the last months of
their life, respectively); Survival rate at one- and two-year were 64% and 48%
respectively. In multi-variate analysis men, older, patients with chronic renale
failure, patients with chronic respiratory failure and patients who didn’t
receive pemetrexed at any time of their management had worse pronostic.
Adjusting analysis on age, gender, comorbidities (hypertension, diabetisi,
COPD), leaving in rural/semi rural area was associated with a better survival
at one and two-year, HR: 0.82 (0.72-0.96) and HR: 0.83 (0.73-0.94); social
deprivation index was not a significant variable for survival. The mean cost
management per patient was 27 624 ± (15894 ) euros (31.4% of this cost was
the cost of pemetrexed and bevacizumab). Conclusion: MPM remained an
uncommon disease, with less of 1000 new cases a year in France, with a very
poor pronostic and a significant burden for National Health system.
Keywords: Mesothelioma, burden of disease, Costs, pronostic
POSTER SESSION 3 – P3.03: MESOTHELIOMA/THYMIC MALIGNANCIES/ESOPHAGEAL
CANCER/OTHER THORACIC
MESOTHELIOMA CLINICAL –
WEDNESDAY, DECEMBER 7, 2016
P3.03-062 RESPONSE TO PEMBROLIZUMAB IN A MALIGNANT
PLEURAL MESOTHELIOMA WITH SARCOMATOID HISTOLOGY: A
CASE REPORT
Martin Faehling 1 , Birgit Schwenk 1 , Sebastian Kramberg 1 , Vera Wienhausen-
Wilke 1 , Matthias Leschke 1 , Jörn Sträter 2
1 Klinik Für Kardiologie Und Pneumologie, Klinikum Esslingen, Esslingen/Germany,
2 Pathologisches Institut, Esslingen/Germany
Background: Malignant pleural mesothelioma is a rare thoracic malignancy
with a poor prognosis. The only proven treatment is chemotherapy with
cisplatinum and pemetrexed. However, mesothelioma with the sarcomatoid
histological subtype is generally poorly responsive to chemotherapy. A
recent small case series in malignant mesothelioma with positive staining
S726 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017