Advances in malignant mesothelioma

Our plain-English summary of Advances in malignant mesothelioma, by B.W. Robinson, R.A. Lake (The New England Journal of Medicine, 2005).

The study

• Authors: B.W. Robinson, R.A. Lake
• Journal: The New England Journal of Medicine
• Published: 2005;353(15):1591-603
• Type of article: Review
• Cited by: 849 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This review article summarized advances in the understanding, diagnosis and management of malignant mesothelioma over the preceding 5 to 10 years. The authors described the tumor as an aggressive cancer of serosal surfaces such as the pleura and peritoneum. Its incidence was increasing worldwide, probably as a result of widespread exposure to asbestos. They reviewed the clinical features and the causes of the disease. They named asbestos as the principal carcinogen and noted continuing debate about whether chrysotile causes mesothelioma, as well as a possible but unproved role for simian virus 40. They also reviewed the epidemiology, including predicted peak years of incidence and estimated compensation costs of up to $200 billion in the United States and $80 billion in Europe over the next 40 years. They outlined four processes by which asbestos may affect the pleura and the biologic features of mesothelioma cells. The diagnostic sections covered cytology, immunohistochemistry, imaging and serum markers. Serum mesothelin-related protein was elevated in 84 percent of patients with mesothelioma and in less than 2 percent of patients with other pulmonary or pleural diseases. Median survival from diagnosis was 12 months. In a phase 3 study of 448 patients, pemetrexed plus cisplatin gave a longer median survival than cisplatin alone (12.1 vs. 9.3 months). The authors also reviewed surgery, radiotherapy, immunotherapy, gene therapy and palliation. They concluded that the rising incidence and compensation costs gave strong moral and economic reasons for urgent, focused research.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a review article, not a new study. The authors reviewed advances from the previous 5 to 10 years in understanding, diagnosing and managing malignant mesothelioma, a cancer of body linings such as the pleura (around the lungs) and peritoneum (in the abdomen). They described asbestos as the principal carcinogen associated with the disease. They wrote that current evidence supports the view that chrysotile itself can cause mesothelioma, though at lower rates than amphiboles. They also wrote that 20 to 30 percent of current cases were in people exposed to asbestos unknowingly and incidentally, and that pleural plaques are a sign of asbestos exposure but not a precursor to mesothelioma. Drawing on other studies, they reported a median survival of 12 months from diagnosis. In one trial of 448 patients, pemetrexed plus cisplatin gave a longer median survival (12.1 months) than cisplatin alone (9.3 months). In an earlier study by Robinson and colleagues, a blood marker, SMRP, was raised in 84 percent of mesothelioma patients. The authors concluded that rising incidence should prompt urgent, focused research.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of advances in the understanding, diagnosis and management of malignant mesothelioma over the previous 5 to 10 years
• Who was studied: No study population of its own; the review covers published research on malignant mesothelioma of serosal surfaces such as the pleura and peritoneum
• Exposure: Asbestos, described as the principal carcinogen associated with malignant mesothelioma, including amphiboles (blue asbestos) and chrysotile (white asbestos)
• Main results:
  • The authors stated that whether chrysotile causes mesothelioma is still debated. They wrote that current evidence, particularly from electron microscopical studies, supports the view that chrysotile itself can cause malignant mesothelioma, at lower rates than amphiboles.
  • People exposed to asbestos unknowingly and incidentally were said to account for 20 to 30 percent of current cases of malignant mesothelioma.
  • Pleural plaques were described as a sign of asbestos exposure but not a precursor to malignant mesothelioma.
  • The rising worldwide incidence was not expected to peak for another 10 to 20 years.
  • Median survival of patients with malignant mesothelioma from the time of diagnosis was given as 12 months (citing another source).
  • In a cited multicenter phase 3 study of 448 patients, those given pemetrexed plus cisplatin had a longer overall median survival (12.1 months) than those given cisplatin alone (9.3 months).
  • Citing data from Robinson et al., the review reported that serum mesothelin-related protein (SMRP) was elevated in 84 percent of patients with malignant mesothelioma and in less than 2 percent of patients with other pulmonary or pleural diseases.
  • In the same cited data (Table 2), 0 percent of 18 patients with pleural plaques or thickening had elevated SMRP, and 5 percent of 22 patients with asbestosis did.
  • The role of simian virus 40 (SV40) as a cofactor was described as unclear and unproved.
• The authors' conclusion: The authors concluded that the increasing worldwide incidence of malignant mesothelioma will result in the death of hundreds of thousands of people and should provide a strong moral imperative for urgent, focused research.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Serosal Surface, Pleura, Peritoneum, Chrysotile, Mesothelioma, Epidemiology, Cytology.

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