Adding chemotherapy to established methods of symptom management does not appear to enhance the quality of life or survival of patients suffering from an asbestos-induced form of lung cancer called malignant plural mesothelioma (MPM). These are the results of MS01, a large UK and Australian study published in the Lancet, which set out to assess the potential benefits of combining active symptom control (ASC) with chemotherapy.
MPM is a deadly form of lung cancer brought on by exposure to asbestos, a mineral which was widely used in building and manufacturing due to its resistance to heat, electricity and chemical damage but has since been banned as a potential health hazard. Although rates of the disease are peaking in North America and Western Europe as a result of the bans introduced on its use and increased health and safety measures, worldwide incidence of the disease continues to rise.
There were nearly 2000 mesothelioma deaths in the UK in 2005. This yearly death rate is expected to increase to a peak of about 2200 by 2013. In future decades the epidemic will shift towards countries that still produce or use large quantities of asbestos like Russia, China, Kazakstan, Brazil, Zimbabwe, India, Thailand.
Richard Stephens, one of the authors of the study from the Medical Research Council (MRC) Clinical Trials Unit, said: “While thousands are and will be affected by this deadly disease, our trial, which is one of the few large trials ever conducted in this disease, emphasises how difficult mesothelioma is to treat. This is mainly because mesothelioma forms in the lining of the lung. This makes it hard to target. Although one of the chemotherapy drugs we looked at, vinorelbine, showed some promise, blanket chemotherapy may not be the way forward. Whilst continuing to try to palliate symptoms and improve quality of life we probably need to concentrate on developing tailored and targeted treatments to improve survival”
Kate Law, Cancer Research UK’s director of clinical trials, said: “Mesothelioma is very difficult to treat and treatment options are limited. These results showed no real benefit from adding these chemotherapy drugs compared with just treating the symptoms of the disease. Any treatment can have serious side effects for patients and these findings highlight that people should not have treatment that is not of proven benefit. Studies like this mean that patients and their doctors can make better informed decisions about the advantages and disadvantages of treatments.”
The MS01 study, funded by Cancer Research UK and the Medical Research Council (MRC), and run by the MRC Clinical Trials Unit (CTU) was a randomised trial involving 409 patients with MPM from 76 centres in the UK and two in Australia. About a third received only active symptom control. Another third received ASC plus MVP chemotherapy (four cycles of mitomycin, vinblastine, and cisplatin every three weeks). The remaining patients received ASC plus vinorelbine chemotherapy (one injection of vinorelbine every week for 12 weeks). The patients’ progress was monitored regularly.
Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma: a multicentre randomised trial
Martin F Muers, Richard J Stephens, Patricia Fisher, Liz Darlison, Christopher M B Higgs, Erica Lowry, Andrew G Nicholson, Mary O’Brien, Michael Peake, Robin Rudd, Michael Snee, Jeremy Steele, David J Girling, Matthew Nankivell, Cheryl Pugh, Mahesh K B Parmar, on behalf of the MS01 Trial Management Group. Lancet vol 371
Funding: Cancer Research UK, the Medical Research Council (UK), the British Thoracic Society, and the June Hancock Mesothelioma Research Fund (UK).
Medical Research Council