Survival rates and treatments costs for pleural mesothelioma patients prior to the emergence of immunotherapy
Pleural mesothelioma is an aggressive cancer that develops on the mesothelial lining of the lung which serves to lubricate and facilitate movement of the lung within the chest cavity. Mesothelioma is caused by exposure to asbestos and can take decades to develop after exposure.
A new study published in the January issue of Advances in Therapy journal examines the methodologies of treatment for patients 65 years of age and older, their outcomes, and their cost of healthcare between 2007 and 2020. The cut-off of 2020 was chosen as the differentiator because it was that year that mesothelioma received its very first indication for an immunotherapy treatment. Once data matures for the period after the advent of immunotherapy, it will be important to revisit this study to make comparisons.
Study demographics
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This study limits its analysis to patients 65 years of age or older, delineated by the patient’s eligibility for, and enrollment in, Medicare, data upon which the study was ultimately based. Demographically, the average age of a mesothelioma patient in the United States is 72 years old. It is important to note, however, that diagnoses among women, and in particular, younger women have been on the rise.
The study included 554 total patients treated between 2007 and 2019. Of those, approximately 80% had epithelioid mesothelioma, and roughly 20% non-epithelioid (sarcomatoid or biphasic). Most patients were white and male, which is also in line with overall mesothelioma diagnoses in the United States.
Mesothelioma standard of care before immunotherapy treatments
For the purpose of this study, researchers used the SEER-Medicare database, which links cancer registry records to Medicare billing claims. The analysis showed that for first line therapy (meaning, first therapy administered after diagnosis) patients in the study received:
- Platinum-based chemotherapy plus pemetrexed (such as cisplatin or carboplatin plus Alimta) (76%)
- Pemetrexed alone (8.5%)
- Combination of pemetrexed, platinum and bevacizumab (an anti-VEGF drug also known as Avastin) (8%)
Of the 554 patients, upon recurrence or progression, 300 initiated second line therapy which included:
- Platinum plus pemetrexed (25%)
- Pembrolizumab (19%)
- Gemcitabine (17%)
In third line therapy, treatment included:
- Gemcitabine (25%)
- Vinorelbine (17%)
- Pembrolizumab (13%)
Overall survival
As a word of caution in interpreting results, this study examined patients with mesothelioma between 2007 and 2020. Mesothelioma treatment has since seen promising advances with the introduction of immunotherapy as a standard of care.
Among the patient population in this study, the median overall survival was 10.8 months with the 5-year survival rate of 5.4%. Patients with mesothelioma of epithelioid histology fared better with a median survival of13.6 months, while the overall survival for non-epithelioid histology patients was a median 5.7 months.
Treatment costs
As would be expected, healthcare use among these mesothelioma patients was frequent, and costs were high, averaging more than $11,000 per month per patient during follow-up. These figures did not include the acquisition cost of therapy drugs or their administration. They included inpatient admissions, outpatient visits and emergency room visits.
These figures highlight the serious burden this disease placed on older adults and the health system in an era before immunotherapy became a standard option. But what this study does not cover, is the additional cost burden placed on mesothelioma patients and their families that includes time off work, expenses to obtain treatment while traveling (transportation, meals, child and pet care), copays, and out-of-pockets treatment expenses.
Why legal support is crucial for mesothelioma patients and their families
Legal support for a mesothelioma or lung cancer can help alleviate many of the financial burdens that arise with the diagnosis. Mesothelioma is a cancer caused by asbestos exposures that often occurred 20, 30, 40 or more years prior to disease development. Workers in construction, shipbuilding, factories, military service members, and many others, often encountered asbestos in their daily work.
Mesothelioma patients and families are encouraged to consult with a qualified law firm the specializes in mesothelioma litigation so they can best understand their options and make informed decisions.
Law firms that specialize in asbestos and mesothelioma, focus on helping patients and families pursue compensation. Belluck Law, LLP has built a national reputation over more than two decades representing mesothelioma and other asbestos-related claims of those who have been harmed by asbestos. The firm has secured over $1 billion in verdicts and settlements for clients affected by asbestos illnesses and emphasizes identifying where and how exposure occurred, including work and military histories.
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