Advances in the diagnosis, evaluation, and management of malignant pleural mesothelioma

Our plain-English summary of Advances in the diagnosis, evaluation, and management of malignant pleural mesothelioma, by D.H. Sterman, S.M. Albelda (Respirology, 2005).

The study

• Authors: D.H. Sterman, S.M. Albelda
• Journal: Respirology
• Published: 2005;10(3):266-83
• Type of article: Review
• Cited by: 84 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is an insidious neoplasm arising from the mesothelial surfaces of the pleural and peritoneal cavities, the pericardium, or the tunica vaginalis. A total of 80% of all cases are pleural in origin. The predominant cause of malignant mesothelioma is inhalational exposure to asbestos, although evidence is increasing to support the hypothesis that simian virus-40 virus plays a role in cocarcinogenesis. Immunohistochemical markers such as calretinin, WT-1, and cytokeratin 5/6 are becoming established diagnostic markers. Preliminary data suggests that a soluble form of mesothelin could serve as a serum marker for established and early cases of mesothelioma. Positron emission tomography with 18-fluorodeoxyglucose in conjunction with computed tomograhy scanning has improved preoperative imaging and staging. Prognostic factors have been identified and verified. Negative indicators include thrombocytosis, high leukocyte counts, poor performance status, and nonepithelial histology. For the first time, there is now evidence that some treatments are increasing the quality and quantity of life for patients with mesothelioma. Chemotherapy, with the new multi-targeted antifolate drug Pemetrexed, combined with cisplatin, has shown superior survival rates in a large phase III trial when compared to cisplatin alone. High-dose intensity-modulated radiotherapy when administered after extrapleural pneumonectomy has resulted in excellent local control. Multimodality treatment programs that combine surgical cytoreduction with novel forms of radiation therapy and more effective chemotherapy combinations may offer significant increases in survival for certain subgroups of mesothelioma patients. Innovative palliative approaches have proved successful in alleviation of the significant symptoms experienced by many mesothelioma patients. Experimental treatments such as immunotherapy and gene therapy present a window of hope for all mesothelioma patients, and in the future, may be combined with 'standard therapy' in multimodality protocols. Patients with adequate performance status should be enrolled into clinical trials where possible. Over the past decade, significant advances have been made on several fronts that have improved the ability to diagnose a stage, define prognosis, and treat malignant pleural mesothelioma.

In plain English

This article is an invited review, not a new study. The authors summarized published research on the diagnosis, staging, prognosis and treatment of malignant pleural mesothelioma. They described inhaled asbestos as the predominant cause, with approximately 80% of pleural cases associated with documented asbestos exposure. Among the studies they reviewed, one study of 188 patients found that thoracoscopic biopsy gave a diagnosis in 98% of cases, compared with 26% for thoracentesis alone. A cited phase III trial reported a median survival of 12.1 months with pemetrexed plus cisplatin, compared with 9.3 months with cisplatin alone. A cited Boston series treated patients with extrapleural pneumonectomy followed by radiation and chemotherapy, and reported overall survival of 36% at 2 years and 14% at 5 years. The authors also gave preliminary results from their own early trial of an interferon-beta gene therapy in eight patients. Of the seven patients re-imaged at 60 days, four had disease progression. The authors concluded that some treatments were increasing the quality and quantity of life for patients with mesothelioma.

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: Invited narrative review of published literature, with some preliminary data from the authors' own phase I gene therapy trial
• Who was studied: Published research on malignant pleural mesothelioma (the review has no study population of its own). It also includes a preliminary report on eight patients, six of them with mesothelioma, given intrapleural Ad.IFN-b at the University of Pennsylvania Medical Center
• Exposure: Not an exposure study. The review describes inhalational asbestos exposure as the predominant cause of malignant mesothelioma, with approximately 80% of pleural mesothelioma cases associated with documented asbestos exposure. It also discusses chrysotile, crocidolite, tremolite, erionite, zeolite and simian virus-40 as factors studied by others
• Main results:
  • Cited study (not the authors' own) of 188 consecutive mesothelioma patients from 1973 to 1990: video-assisted thoracoscopic biopsy gave a diagnosis in 98% of cases, compared with 26% for thoracentesis alone and 39% for pleural fluid cytology with closed pleural biopsy
  • Cited phase III randomized trial (not the authors' own) of 456 chemotherapy-naive mesothelioma patients: median survival was 12.1 months in the pemetrexed/cisplatin group versus 9.3 months in the cisplatin-only group (P = 0.020). The hazard ratio for death was 0.77
  • Cited Brigham and Women's Hospital series (not the authors' own) of extrapleural pneumonectomy followed by radiation and chemotherapy: overall survival was 36% at 2 years and 14% at 5 years. Patients with epithelial mesothelioma, no mediastinal lymph node involvement and negative resection margins had a 5-year survival rate of 46%
  • Cited study (not the authors' own) of a serum test for soluble mesothelin: raised levels were found in 37 of 44 patients with mesothelioma (printed as 87%), in 3 of 160 patients with other cancers or inflammatory lung or pleural diseases (2%), and in none of 28 controls without past asbestos exposure
  • The authors' own preliminary phase I trial of intrapleural Ad.IFN-b: of the seven patients re-imaged at 60 days, 2 of 3 at Dose Level 1 and 2 of 4 at Dose Level 2 had disease progression. The other two patients at Dose Level 2 had stable disease. None of the first three patients had a dose-limiting toxicity or serious adverse event
  • Extrapleural pneumonectomy, as described in the review, carries morbidity of up to 25% and an operative mortality of 5 to 31%, depending on the experience of the centre and the patient's condition before surgery
• The authors' conclusion: The authors concluded that advances over the past decade had improved diagnosis, staging, prognosis and treatment. In their view, some treatments were increasing quality and quantity of life, and multimodality programs may offer significant increases in survival for certain subgroups. They stated that patients with adequate performance status should be enrolled into clinical trials where possible

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Neoplasm, Pericardium, Tunica Vaginalis, Calretinin, Wilms Tumor 1 (WT-1), Cytokeratin 5/6.

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