Malignant pleural mesothelioma in the elderly patient. Retrospective study in the centers of Alessandria and Casale Monferrato

Introduction: This study aims to retrospectively evaluate the management of the diagnostic and therapeutic procedure and the clinical outcome of a case series of elderly patients followed at the Hospitals of Alessandria and Casale Monferrato. Methodology: From a total of 343 patients with MPM, treated between January 2005 and November 2011 at the Hospital SS. Antonio e Biagio and Cesare Arrigo Hospital in Alessandria and SS. Spirito Hospital in Casale Monferrato, 124 patients aged ≥70 years were selected. The following were analyzed for each patient: age, asbestos exposure, sex, histology, stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), Charlson Comorbidity Index (CCI), and treatment performed. Results: Median overall survival (OS) was 9 months. The most frequent histotype was epithelioid (59%). Asbestos exposure was documented in 96% of cases. The diagnosis of MPM was documented by histological examination in 91% of patients (the rate of histological diagnosis from the data of the Italian Mesothelioma Registry was much lower). The stage at diagnosis in most cases (60%) was reported as I-II. The ECOG-PS of this case series was between 0 and 1 in almost all cases, confirming that old age is not synonymous with poor performance status. No major comorbidities were observed in 64% of cases, whereas a mean score of 4 and 5 was found in 18% and 10% of cases, respectively. Survival analysis showed a negative impact on median OS in the presence of a CCI ≥4. Pemetrexed-based chemotherapy in this elderly population was found to be feasible with a more than acceptable toxicity profile. Conclusion: This study demonstrated the influence also in the elderly population of some prognostic factors such as histological subtype, IMIG stage, presence of comorbidities according to CCI, and therapy with pemetrexed-based or non-pemetrexed-based regimens. On the basis of these analyses, greater attention to this category of patients is needed, hoping for the possibility of conducting prospective studies aimed also at the elderly population.