MARS 2 trial: the future of pleurectomy decortication in pleural mesothelioma
Mené au Royaume-Uni sur 335 patients atteints d'un mésothéliome pleural (durée médiane de suivi : 22,4 mois), cet essai randomisé multicentrique de phase III évalue l'intérêt, du point de vue de la survie globale, d'ajouter une pleurectomie/décortication étendue à une chimiothérapie
In The Lancet Respiratory Medicine, Eric Lim and colleagues 1 present results of the MARS 2 trial, which sought to answer the question of whether (extended) pleurectomy decortication has an effect on survival and quality of life of patients with resectable pleural mesothelioma. The principal evidence for surgery before the MARS 2 trial was retrospective case series, and no controlled trials were available. The trial has a randomised, pragmatic design and the control group is chemotherapy alone. Surprisingly, results showed superior overall survival in the chemotherapy alone group (24·8 months vs 19·3 months) and the surgery group had worse quality of life, a higher proportion of adverse events, and higher costs. Although these results should be considered relevant for clinical practice—discouraging surgery outside controlled settings of clinical studies or multidisciplinary defined therapeutic strategies in specialised centres—we do not think that the results of this trial alone answer the question it posed.
The Lancet Respiratory Medicine , commentaire, 2023