Treatment options for malignant pleural mesothelioma (MPM) are still being researched. Therefore, we analyzed the overall survival of MPM patients with a variety of multimodal treatment protocols, assessing the impact of immunotherapy, chemotherapy, and surgery on their condition. Our integrated healthcare system analyzed MPM patients seen between January, 1, 2009 and December 31, 2020. Treatment protocols were used to divide patients into four categories: chemotherapy (CT), immunotherapy with or without chemotherapy (iCT), surgery with chemotherapy (sCT), and surgery with immunotherapy and chemotherapy (siCT). Researchers compared these groups and many subgroups based on baseline variables and overall patient survival.

A total of 179 patients were involved in the study. There were no significant differences in demographic characteristics between the study groups, including age, sex, race/ethnicity, the Charlson Comorbidity Index, or Eastern Cooperative Oncology Group performance status. Median (95% CI) survival times for CT (N=109), iCT (N=35), sCT (N=26), and siCT (N=9) patients were 11.7 (9.9-16.3), 18.2 (14.5-29.8), 20.7 (11.6-37.2), and 22.6 (19.7-37.8) months, respectively (P<.001). The median survival time for individuals who had immunotherapy was 19.7 months (range: 17.4 to 29.8), while those who did not have immunotherapy fared far worse at 12.3 months (range: 10.6 to 17.3) (P=.023). With surgery, patients had a median survival time of 21.7 months (95% CI: 17.6–34.8) compared to 13.6 months (95% confidence interval: 11.51–17.33) without it (P=.007). In a study of patients with biphasic/sarcomatoid subtypes, those who underwent immunotherapy had a 12-month survival rate of 76.2% (55.8%-100.0%) compared to 13.6% (4.8%-39.0%) for those who did not (P<.001).

The longest lifetimes were seen in MPM patients who underwent surgery and immunotherapy as part of multimodal treatment protocols. The survival rates of patients treated with either surgery or immunotherapy are similar. Research is needed to determine the efficacy of immunotherapy as part of MPM’s multimodal treatment approach.