Approved and emerging treatments of malignant pleural mesothelioma in elderly patients

Our plain-English summary of Approved and emerging treatments of malignant pleural mesothelioma in elderly patients, by G.L. Ceresoli, A. Rossi (Expert Review of Respiratory Medicine, 2019).

The study

• Authors: G.L. Ceresoli, A. Rossi
• Journal: Expert Review of Respiratory Medicine
• Published: 2019;13(12):1179-1188
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm with asbestos exposure as the dominant etiologic agent. Owing to the long latent period following exposure, MPM is often diagnosed late in life. Despite this, elderly patients are under-represented in clinical trials. To date, data regarding the tolerability and efficacy of anticancer treatments for elderly patients affected by MPM are still lacking.Areas covered: The current state-of-the-art of approved treatments employed in the treatment of MPM elderly patients is reviewed and discussed, with a look to emerging therapies. A structured search of bibliographic databases for peer-reviewed research literature and of main meeting abstracts using a focused review question was undertaken.Expert opinion: Even though the median age of MPM patients enrolled in the most recent experimental trials is increasing, no specific analysis has been reported so far in the elderly. Moreover, no data are available for the 'oldest of the elderly' (>75 years). Treatment of elderly patients with MPM is one of the major challenges to the clinician. There is a clear need of large, well-conducted retrospective studies and above all of prospective investigations in this patient population, both in the first-and in the second-line setting.

In plain English

This article is a review, not a new study. The authors searched databases and meeting abstracts on treating malignant pleural mesothelioma in elderly patients. Asbestos appears only as background. Discussing recent experimental trials, the authors wrote that none had analysed elderly patients separately and that no data were available for patients over 75. A reviewed US National Cancer Database analysis of 4526 patients aged 80 or older with newly diagnosed, non-metastatic disease found that 8% had surgery using a defined surgical technique, and 63% received no specific cancer treatment. Among those who had surgery, 11.0% died within 30 days and 28.5% within 90 days. A pooled analysis of two carboplatin-pemetrexed trials found no significant difference in disease control, time to progression or survival between patients aged 70 or older and younger patients. The older patients had somewhat more blood-related side effects. The authors concluded that surgery should be considered only in very selected, fit elderly patients, that carboplatin-based chemotherapy can be an option for patients who cannot have surgery, mainly as first-line treatment, and that prospective studies are needed.

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: Review of published literature and meeting abstracts (structured search)
• Who was studied: Published studies on elderly patients with malignant pleural mesothelioma. The review has no patients of its own.
• Exposure: Not an exposure study. The review covered treatments: surgery and multimodality treatment, chemotherapy (pemetrexed with platinum drugs and others), targeted therapies and immunotherapy. Asbestos is mentioned only as background cause.
• Main results:
  • The authors found that no recent experimental trial had reported a specific analysis in elderly patients.
  • In the same passage on recent experimental trials, the authors wrote that no data were available for patients older than 75.
  • A reviewed US National Cancer Database analysis covered patients aged 80 or older with newly diagnosed non-metastatic disease. Only 8% of these patients had surgery using a defined surgical technique, nearly all pleurectomy/decortication.
  • In the same database analysis, most patients (63%) received no specific cancer treatment.
  • In the same database analysis, among patients who had surgery, 30-day mortality was 11.0% and 90-day mortality was 28.5%.
  • A reviewed pooled analysis of two phase II carboplatin-pemetrexed trials compared patients aged 70 or older with younger patients. It found no significant difference between the groups in disease control, time to progression or overall survival.
  • In that pooled analysis, side effects were comparable overall, with slightly more blood-related toxicity in older patients.
  • The authors judged that surgery and multimodality treatment should be considered only in very selected, fit elderly patients. They named pleurectomy/decortication as the intervention of choice.
  • The authors called for large retrospective studies and especially prospective studies in elderly patients.
• The authors' conclusion: The authors concluded that chemotherapy can be an option for elderly patients who cannot have surgery, mainly as first-line treatment with carboplatin-based combinations.
• Limitations the authors state:
  • The authors note that the few retrospective chemotherapy studies in elderly patients are post-hoc analyses of selected patients already judged eligible for trial chemotherapy.
  • The authors note that, in the Australian survey they reviewed, very few patients over 80 received chemotherapy, which makes those data hard to interpret.

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: Pleural Mesothelioma, Neoplasm, Asbestos Exposure, Clinical Trial, Second-Line Therapy.

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