Chemotherapy for malignant pleural mesothelioma: a review of current management and a look to the future

Our plain-English summary of Chemotherapy for malignant pleural mesothelioma: a review of current management and a look to the future, by A.K. Nowak (Annals of Cardiothoracic Surgery, 2012).

The study

• Author: A.K. Nowak
• Journal: Annals of Cardiothoracic Surgery
• Published: 2012;1(4):508-15
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

This narrative review described the systemic treatment of advanced malignant pleural mesothelioma (MPM) as of 2012 and looked at future directions. Chemotherapy as part of multimodality treatment was not covered. The author noted that routine practice had not changed since 2003, when the 'Emphacis' trial showed that cisplatin plus pemetrexed improved median survival from 9.3 to 12.1 months compared with cisplatin alone. Adding raltitrexed to cisplatin increased survival from 8.8 to 11.4 months. Carboplatin was often substituted for cisplatin, although randomised evidence did not support this. Unresolved questions included maintenance therapy, the number of cycles, when to start treatment and how to predict response. None of the candidate markers discussed (thymidylate synthase, ERCC1, folate receptor, serum mesothelin, FDG-PET) was yet useful for selecting patients. In the second-line setting, re-treatment with pemetrexed and a platinum was considered a reasonable option for fit patients with previous disease control, but no agent had shown benefit in a randomised trial. EGFR inhibitors and imatinib showed no activity. VEGF receptor inhibitors gave response rates around 10%. Possible targets linked to BAP1 and NF2 loss and to the HGF/c-Met pathway were discussed. The author concluded that progress would need well-designed randomised trials, international co-operation and high-quality annotated tissue collections, to which surgeons could contribute.

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 article is a review, labelled a Perspective, by a single author. It covers drug treatment for advanced malignant pleural mesothelioma. It did not study asbestos exposure or any new patients, and it left aside chemotherapy given as part of combined treatment with surgery. The author summarised earlier studies. In one cited randomised trial, adding pemetrexed to cisplatin raised median survival from 9.3 to 12.1 months (P=0.02) compared with cisplatin alone in patients with advanced disease. In a cited British trial, the combined chemotherapy arms showed no overall survival benefit over active symptom control (HR 0.89; P=0.29). For second-line treatment, a cited trial found more partial responses and longer progression-free survival with pemetrexed than with best supportive care. Among newer targeted drugs, gefitinib, erlotinib and imatinib showed no evidence of activity, and drugs acting on the VEGF receptor had response rates around 10%. The author described cisplatin with pemetrexed as standard first-line therapy worldwide for patients not suitable for aggressive surgery. The author concluded that progress will require international co-operation and large, well-documented tissue collections. The author noted that the overview of possible drug targets was not comprehensive.

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 (labelled 'Perspective') by a single author of drug treatment for malignant pleural mesothelioma
• Who was studied: No new patients; the article reviewed published trials and studies of drug treatment in patients with advanced malignant pleural mesothelioma
• Exposure: Not an asbestos exposure study; the article discusses chemotherapy and targeted drug treatments for mesothelioma
• Main results:
  • In a cited randomised trial (Emphacis), cisplatin plus pemetrexed improved median survival from 9.3 to 12.1 months (P=0.02) compared with cisplatin alone in patients with advanced disease
  • In the cited British MS01 trial, the combined chemotherapy arms showed no overall survival benefit compared with active symptom control (HR 0.89; P=0.29)
  • In a cited second-line trial, patients given pemetrexed had a significantly higher rate of partial response and disease control, and longer progression-free survival, than those given best supportive care
  • In cited studies, single-agent gefitinib, erlotinib and imatinib showed no evidence of activity, even as first-line treatment
  • In cited studies, drugs inhibiting the VEGF receptor had response rates around 10% and progression-free survival between 3 and 4 months
  • The author reported that cisplatin plus pemetrexed has become standard first-line therapy worldwide for patients not suitable for aggressive surgery
• The authors' conclusion: The author concluded that moving mesothelioma treatment toward precision medicine will require an international co-operative effort and extensive, high-quality, well-annotated tissue collections
• Limitations the authors state:
  • The author states that the discussion of possible drug targets is not comprehensive
  • The review does not cover chemotherapy given as part of multimodality treatment, which is addressed in a companion paper

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Cisplatin, Pemetrexed (Alimta), Median Overall Survival, Raltitrexed, Carboplatin, Mesothelin.

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