MARS 2: extended pleurectomy decortication plus chemotherapy versus chemotherapy alone for pleural mesothelioma
Adding lung-sparing radical surgery to chemotherapy for pleural mesothelioma did not lengthen life; patients who had surgery lived slightly less long, had more complications and worse quality of life, so routine surgery is no longer recommended.
Overview
Multicentre randomised trial in the United Kingdom of 335 patients with resectable pleural mesothelioma randomised to extended pleurectomy decortication plus platinum-pemetrexed chemotherapy or chemotherapy alone.
Median overall survival was 19.3 months with surgery against 24.8 months without (hazard ratio 1.28); surgery caused more serious adverse events and worse quality of life in the first year, at higher cost.
- Median overall survival 19.3 vs 24.8 months; hazard ratio 1.28 favouring no surgery.
- Serious adverse events 3.6 times more common in the surgery arm.
Radical surgery for pleural mesothelioma should be confined to trials; effusion is managed with pleurodesis or indwelling catheters and treatment is systemic.
- Surgical quality varied across centres; proponents argue selected patients in expert hands may still benefit.
- Most patients had epithelioid disease.