No difference in quality of life by adding raltitrexed before cisplatin

An EORTC randomised trial shows no difference in quality of life, but improved survival and a clinically meaningful improvement in dyspnoea by adding raltitrexed before cisplatin in patients with malignant pleural mesothelioma.Malignant pleural mesothelioma (MPM) is a relatively rare, aggressive disease, and median survival is 7-11 months after diagnosis, so health-related quality of life (HRQOL) is an important issue for treatment. This randomised controlled trial included patients with unresectable MPM, not pretreated with chemotherapy and 124 were randomised to first-line treatment with intravenous cisplatin and 126 to cisplatin preceded by raltitrexed. The HRQOL was measured using the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30) and EORTC Lung Cancer Module (QLQ-LC13), at baseline, before every treatment cycle, at the end of treatment, and then every six weeks for one year. Previously reported results showed that the response rate was 13.6% in the cisplatin alone group and 23.6% in the raltitrexed and cisplatin group. Median overall survival was 8.8 months and 11.4 month respectively (p=0.048). The global HRQOL scale was similar at baseline and had little change at all time points (p = 0.848). Nausea, vomiting and fatigue increased with time but was similar between groups. Because of lack of compliance, there were too few patients available after the 5th cycle to have meaningful results after this time. Dyspnoea improved in both groups with time, and the authors reported that this was clinically meaningful in the cisplatin and raltitrexed arm. Most scales of the EORTC QLQ-C30 or LC13 showed stabilisation of HRQOL and there were few clinically significant differences between the treatment arms. Reference...