ArticleAdvances in therapy2026
Treatment Patterns, Clinical Outcomes, Health Care Resource Use, and Costs in Older Adults with Malignant Pleural Mesothelioma in the United States, 2007-2020.
Article in Advances in therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionMalignant pleural mesothelioma (MPM) is a rare malignancy typically attributed to occupational asbestos exposure and associated with dismal survival outcomes. The standard of care for unresectable MPM was platinum-based chemotherapy until the approval of immunotherapy in 2020. We examined treatment patterns, clinical outcomes, health care resource use (HCRU), and costs in patients with MPM to understand disease burden before the first immunotherapy approval.
methodsThis retrospective study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare deidentified database in the US to select patients aged ≥ 65 years who initiated first-line therapy (1L, index event) for advanced MPM (regional extension or distant) diagnosed between 2007 and 2019. Eligible patients had continuous Medicare enrollment from the diagnosis date to ≥ 3 months post-index date, with ≥ 6-month follow-up after 1L initiation. Kaplan-Meier methods were used to estimate real-world time to treatment discontinuation (rwTTD) and overall survival (OS). Data cutoff was December 31, 2020.
resultsAmong 554 patients with MPM who initiated 1L, median age was 74 years; most were white (95.0%) and male (73.7%). The most common 1L regimens were platinum-pemetrexed (75.6%), pemetrexed monotherapy (8.5%), and bevacizumab-platinum-pemetrexed therapy (8.1%); the median rwTTD of 1L therapy was 5.3 (95% CI, 4.2-6.3) months. Of 554 patients, 300 (54.2%) initiated second-line therapy (2L), and 120 (21.7%) initiated third-line therapy (3L). Platinum-pemetrexed (25.0%) and gemcitabine (25.0%) were the most common 2L and 3L, respectively. Median OS was 16.3 (95% CI, 15.4-17.8) months, with 5-year survival of 7.9% (95% CI, 5.5-10.9). Mean per-patient-per-month all-cause inpatient admissions, outpatient visits, emergency department visits, and total costs were 0.04, 1.74, 0.18, and $11,432, respectively.
conclusionThe study highlights a substantial clinical and economic burden among patients with advanced MPM who received 1L chemotherapy in the years preceding immunotherapy approvals, underscoring the need for more effective therapies to improve outcomes.
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