Effect of induction chemotherapy on lung function and exercise capacity in patients affected by malignant pleural mesothelioma

Objectives: The effect of induction chemotherapy (IC) on lung function and exercise capacity in patients with malignant pleural mesothelioma (MPM) has not been largely examined. The aim of this study was to evaluate the changes in pulmonary function and oxygen consumption following IC in patients with MPM. Methods: Between 2004 and 2009, 36 consecutive patients (mean age 62.1 ± 1.5 years, M/F = 25/11) were prospectively investigated. Data concerning medical history, histology, staging and response to chemotherapy were collected. All patients underwent pulmonary function test before (in the absence of pleural effusion) and after chemotherapy (platinum-based agent plus pemetrexed); 23 out of 36 patients also performed a cardiopulmonary incremental exercise test. Results: An epithelioid histotype was documented in 88.8% of patients. A partial response to chemotherapy was observed in 44.5% of cases and 36.1% of patients experienced grade 2–3 toxicity. A significant improvement in forced expiratory volume in 1 s (FEV1) (0.13 ± 0.30 l; P = 0.01), in VO2 peak (1.76 ± 2.91 ml kg−1 min−1; P = 0.005), in PaO2 at rest (4.76 ± 9.84 mmHg; P = 0.03) and in PaO2 at peak exercise (6.26 ± 12.72 mmHg; P = 0.04) was detected. The diffusion capacity of the lung for carbon monoxide (DLCO) also increased (1.25 ± 4.68 ml min−1 mmHg−1), although not significantly (P = 0.20). The stratified analysis based on the response to IC showed a significant improvement in FEV1, forced vital capacity (FVC) and vital capacity (VC) (both absolute and percentage of predicted values) only in patients with a partial response. Conclusions: An improvement in lung function and exercise capacity was seen after IC in patients with MPM. These data suggest that IC does not compromise cardiopulmonary performance in this subset of patients.