Surgery often ineffective for most mesothelioma patients

Mesothelioma is a fatal cancer invariably associated with past exposure to asbestos dust and fibres. Despite all types of asbestos having been outlawed for over 25 years, it is still responsible for almost 2,500 deaths in the UK each year according to the Health and Safety Executive (HSE).

Treatment for the condition includes chemotherapy and radiotherapy, single or dual immunotherapy drugs, but can also include surgery with removal of part or whole of the pleura – referred to as a “pleurectomy decortication”.

The recently published MARS2 study was a phase 3 randomised controlled trial in the UK, across 26 hospitals which assessed the benefits to patients with epithelioid mesothelioma of chemotherapy alone opposed to surgery (extended pleurectomy decortication) and chemotherapy. Patients were randomly assigned following two cycles of chemotherapy.

The findings

The MARS2 study revealed that the median survival time was shorter for those patients in the surgery and chemotherapy group – 19.3 months, compared to a median survival time of 24.8 months for patients treated with chemotherapy alone.

Researchers noted a total of 318 serious adverse events amongst those treated by surgery compared to just 119 in the chemotherapy group. These “events” included increased cardiac and respiratory disorders and infections driving the conclusion that “surgery does not improve outcomes for most mesothelioma patients”.

Although these findings will be viewed as disappointing, recent developments to include immunotherapy drugs and significant ongoing research lend hope that measurable improvements will be seen both to longevity and progression free survival for mesothelioma patients.