Advances in the diagnosis, treatment and prognosis of malignant pleural mesothelioma

Our plain-English summary of Advances in the diagnosis, treatment and prognosis of malignant pleural mesothelioma, by W. Zhang, X. Wu, L. Wu, et al (Annals of Translational Medicine, 2015).

The study

• Authors: W. Zhang, X. Wu, L. Wu, W. Zhang, X. Zhao
• Journal: Annals of Translational Medicine
• Published: 2015;3(13):182
• Type of article: Review
• Cited by: 46 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare cancer originated from pleural mesothelial cells. MPM has been associated with long-term exposure to asbestos. The prognosis of MPM is poor due to the difficulty of making diagnosis in the early stage, the rapid progression, the high invasiveness and the lack of effective treatment. Although the incidence of MPM is low in China to date, it has a tendency to increase in the coming years. The variety of clinical features may cause the delay of diagnosis and high rate of misdiagnosis. The diagnosis of MPM is based on biopsy of the pleura and immunohistochemistry. As China has become the largest country in the consumption of asbestos, it would give rise to a new surge of MPM in the future. The current treatment of MPM is multimodality therapy including surgery, radiotherapy, chemotherapy and immunotherapy. Two surgical procedures are commonly applied: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). Three dimensional conformal radiotherapy is used to denote a spectrum of radiation planning and delivery techniques that rely on the 3D imaging to define the tumor. Cisplatin combined with pemetrexed (PEM) is the first-line chemotherapy for MPM. The principal targets in immunotherapy include T cells (Treg), CTLA-4 and PD-1. The diagnosis, treatment and prognosis still remain a major challenge for clinical research and will do so for years to come.

In plain English

This article was a review of published research on malignant pleural mesothelioma (MPM), a cancer of the lining around the lungs. It was written by thoracic surgery researchers in China and Canada. It reported no new patient data and did not describe how articles were chosen. Citing earlier work, the authors wrote that 75-87% of MPM patients have a history of asbestos exposure, mostly with crocidolite. They gave MPM incidence in China as approximately 0.1-0.6 per 10 million, lower than the global incidence, possibly because of misdiagnosis. They added that China's position as the largest asbestos-consuming country could lead to a surge of MPM. The review covered tumor types, symptoms, diagnosis, surgery, radiotherapy, chemotherapy, immunotherapy and targeted drugs. It described a phase III trial in which median survival was about 9.3 months with cisplatin alone and 12.1 months with cisplatin plus pemetrexed. The authors concluded that current therapies have very limited effect and that the prognosis is quite poor.

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 literature
• Who was studied: No patients were studied directly. The article reviewed published studies on malignant pleural mesothelioma.
• Exposure: Asbestos exposure, mostly crocidolite according to a cited study, discussed as the most common cause of MPM. Other factors mentioned include SV40, erionite and radiation.
• Main results:
  • Citing other studies, the review stated that 75-87% of MPM patients have a history of asbestos exposure, mostly with crocidolite.
  • The review gave MPM incidence in China as approximately 0.1-0.6 per 10 million, lower than the global incidence.
  • The authors wrote that China's status as the largest asbestos-consuming country could lead to a surge of MPM in the future.
  • Citing other work, the review stated that untreated MPM patients have a median survival of about 4 to 12 months.
  • The review reported that deaths around the time of surgery with extrapleural pneumonectomy were once as high as 32% and had fallen to 4%.
  • For pleurectomy/decortication, the review reported deaths around the time of surgery of about 1.5-5.4%.
  • In a cited phase III trial, median survival was about 9.3 months with cisplatin alone and 12.1 months with cisplatin plus pemetrexed. Response rates were 16.7% and 41.3%.
  • In a cited phase II trial (Kindler et al.), adding bevacizumab to gemcitabine/cisplatin did not significantly improve progression-free or overall survival.
  • In a cited phase II trial (Garland et al.), erlotinib given alone was not effective in MPM.
  • The review stated that the localized type of the tumor is generally believed to be unrelated to smoking and asbestos exposure.
• The authors' conclusion: The authors concluded that current therapies have very limited efficacy and that the prognosis of MPM is quite poor.

Topics

Medical terms in this study, explained in our Lexicon: Prognosis, Pleural Mesothelioma, Mesothelial Cells, Misdiagnosis, Biopsy, Pleura, Immunohistochemistry, Multimodal Therapy.

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