Advances in systemic therapy for malignant mesothelioma: future perspectives

Our plain-English summary of Advances in systemic therapy for malignant mesothelioma: future perspectives, by N. Sobhani, S.P. Corona, D. Bonazza, et al (Future Oncology, 2017).

The study

• Authors: N. Sobhani, S.P. Corona, D. Bonazza, A. Ianza, T. Pivetta, G. Roviello, M. Cortale, A. Guglielmi, F. Zanconati, D. Generali
• Journal: Future Oncology
• Published: 2017;13(23):2083-2101
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is a rare and aggressive form of cancer affecting the mesothelium. This mainly occupational disease is becoming more common in those countries where asbestos has been used for industrial applications. Notwithstanding the progress made in the field, patients do not survive more than 12 months on average with standard treatment. With the advent of next generation sequencing, it is now possible to study the mutational landscape of each tumor with the aim of identifying the genetic aberrations driving tumorigenesis. This review encompasses the latest research in the field, with particular attention to new chemotherapy combinatorial regimens, molecular targets and immunotherapies, providing a comprehensive picture of the current and future treatment options for malignant mesothelioma patients.

In plain English

This article is a narrative review, not a new study. The authors described published and ongoing clinical trials of drug treatments for malignant mesothelioma, covering combination chemotherapy, immunotherapy, and drugs aimed at specific molecular targets. Citing earlier work, the review stated that asbestos exposure causes the disease in more than 80% of cases. Among the trials it described, adding pemetrexed to cisplatin improved overall survival compared with cisplatin alone (12.1 vs 9.3 months). The review reported that several targeted drugs (erlotinib, dasatinib, bevacizumab, bortezomib, vorinostat and belinostat) failed to improve outcomes in randomized trials. Everolimus produced one partial response among 56 patients. For immunotherapy, tremelimumab given alone did not meet its main goal of improving survival in a Phase IIb trial. A WT1 vaccine trial in 40 patients with pleural mesothelioma reported a median progression-free survival of 11.4 months with the vaccine versus 5.7 months with placebo. The authors concluded that pemetrexed with cisplatin remains the gold standard and that targeted immunotherapy holds great promise. They also noted that early immunotherapy studies were small.

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 published and ongoing clinical trials of systemic therapy for malignant mesothelioma
• Who was studied: No new patients were studied. The review covered published clinical trials and ongoing registered trials (listed in three tables) of treatments for malignant mesothelioma, mostly malignant pleural mesothelioma, with some peritoneal mesothelioma trials.
• Exposure: This is a review of treatments, not of asbestos exposure. In its background, citing earlier work, the review stated that asbestos exposure causes the disease in more than 80% of cases.
• Main results:
  • In a cited Phase III trial, cisplatin plus pemetrexed improved overall survival compared with cisplatin alone (12.1 vs 9.3 months).
  • The review described pemetrexed with cisplatin as still the gold standard, with 15-month overall survival.
  • Tyrosine kinase inhibitors (erlotinib, dasatinib), bevacizumab, bortezomib, vorinostat and belinostat all failed to improve outcomes in randomized clinical trials, as reported by the review.
  • In a cited trial in pretreated advanced pleural mesothelioma, everolimus produced one partial response among 56 patients (objective response rate 2%; 95% CI 0 to 12%).
  • Tremelimumab given alone in a Phase IIb trial did not meet its primary endpoint of improving overall survival in second-line treatment (objective response rate 3%, median overall survival 10.7 months).
  • In a cited Phase II trial of 89 patients given amatuximab (MORab-009) with pemetrexed and cisplatin, median progression-free survival was 6.1 months and median overall survival was 14.8 months.
  • In a cited randomized Phase II trial of a WT1 vaccine in 40 patients with malignant pleural mesothelioma, median progression-free survival was 11.4 months in the vaccine arm versus 5.7 months in the placebo arm.
• The authors' conclusion: The authors concluded that targeted immunotherapy holds great promise for malignant mesothelioma, following results in melanoma and non-small-cell lung cancer, and that the outcomes of many ongoing trials are awaited.
• Limitations the authors state:
  • The authors noted that the early immunotherapy studies included small numbers of patients.
  • The authors cautioned that a gain in progression-free survival does not always translate into longer survival.
  • The authors noted that measurement of PD-L1, a marker used to select patients for some immunotherapies, is not standardized.

Topics

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

Medical terms in this study, explained in our Lexicon: Systemic Therapy, Malignant Mesothelioma, Mesothelium, Occupational Disease, Tumorigenesis, Chemotherapy.

Related studies

• Advances in the systemic therapy of malignant pleural mesothelioma — D.A. Fennell, G. Gaudino, et al. (2008)
• Searching for targets for the systemic therapy of mesothelioma — R.A. Stahel, W. Weder, et al. (2015)
• Tumour infiltrating lymphocytes and PD-L1 expression as potential predictors of outcome in patients with malignant pleural mesothelioma — N. Sobhani, G. Roviello, et al. (2019)
• Novel platinum agents and mesenchymal stromal cells for thoracic malignancies: state of the art and future perspectives — F. Petrella, I. Rimoldi, et al. (2018)
• Tumour treating fields therapy for glioblastoma: current advances and future directions — O. Rominiyi, A. Vanderlinden, et al. (2021)
• Priming the tumor immune microenvironment with chemo(radio)therapy: A systematic review across tumor types — T. van den Ende, H.G. van den Boorn, et al. (2020)

Browse more research in Future Oncology, or return to medical research.