Current concepts in malignant pleural mesothelioma

Our plain-English summary of Current concepts in malignant pleural mesothelioma, by A.J. Kaufman, H.I. Pass (Expert Review of Anticancer Therapy, 2008).

The study

• Authors: A.J. Kaufman, H.I. Pass
• Journal: Expert Review of Anticancer Therapy
• Published: 2008;8(2):293-303
• Type of article: Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a rare but lethal cancer associated with asbestos exposure. Worldwide, the incidence of MPM is expected to increase over the next 20 years. The molecular and genetic profiling of MPM tumors and patients, and improved understanding of the pathogenesis of MPM may lead to novel diagnostic, preventative and therapeutic strategies. Treatment options for MPM remain limited and no consensus exists at this time. Multimodality therapy that combines surgery, chemotherapy and radiation offers the best chance for long-term survival in select patients.

In plain English

This article is a narrative review, by authors at New York University Medical Center, of published research on malignant pleural mesothelioma (MPM), a cancer associated with asbestos exposure. It reported no new data; its figures come from studies it cites. The review described asbestos fiber types. It stated that crocidolite is considered the most oncogenic form and that researchers have debated whether chrysotile also causes MPM. It cited a latency from first exposure of 15–40 years and a median survival from diagnosis of 9–12 months. It described erionite exposure in Cappadocia, Turkey, where MPM caused over 50% of deaths in three villages, and called the role of the SV40 virus controversial. It also reviewed genetics, blood markers, imaging, diagnosis and treatment. It cited a trial of 456 patients in which cisplatin plus pemetrexed gave a 3-month longer average survival than cisplatin alone. The authors noted that no randomized trials have compared the main operations. They concluded that no treatment consensus exists and that combined surgery, chemotherapy and radiation offers the best chance of long-term survival in select patients.

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 study population of its own. The authors reviewed published research on malignant pleural mesothelioma (epidemiology, causes, diagnosis, staging and treatment). The article does not describe a literature search method or date range.
• Exposure: The review discussed asbestos in general: amphibole types (crocidolite, amosite, tremolite, anthophyllite, actinolite) and the serpentine type (chrysotile). It also discussed erionite (an asbestos-like fiber) in Cappadocia, Turkey, and simian virus 40 (SV40) as a possible co-factor.
• Main results:
  • Citing other studies, the review stated that crocidolite is considered the most oncogenic form of asbestos.
  • The review stated that whether chrysotile also causes MPM has been debated.
  • Citing other sources, the review gave a latency from first exposure to MPM of 15–40 years.
  • Citing other sources, the review gave a median survival from diagnosis of 9–12 months.
  • Citing other studies, the review reported that in villages in Cappadocia, Turkey, with long-term erionite exposure, MPM was responsible for over 50% of deaths.
  • The review described the role of SV40 in MPM as still controversial.
  • In a cited study (reference 63) using a cut-off of 48.3 ng/ml, serum osteopontin had a sensitivity of 77.6% and a specificity of 85.5% when comparing asbestos-exposed people without MPM with MPM patients.
  • In a cited Phase III trial of 456 chemotherapy-naive patients, cisplatin plus pemetrexed gave a 3-month longer average survival time than cisplatin alone.
  • In a cited study of extrapleural pneumonectomy with adjuvant chemoradiation (Sugarbaker and colleagues), overall survival for all patients was 38% at 2 years and 15% at 5 years.
  • The review reported that cited trials of the targeted drugs erlotinib and gefitinib showed no efficacy.
• The authors' conclusion: The authors concluded that treatment options for MPM remain limited and that no consensus exists. In their view, multimodality therapy combining surgery, chemotherapy and radiation offers the best chance for long-term survival in select patients.
• Limitations the authors state:
  • The authors noted that no randomized controlled trials have compared extrapleural pneumonectomy with pleurectomy/decortication, or surgery with nonsurgical treatment.
  • The authors stated that, because of the lack of randomization, the level of evidence on surgical management remains low.
  • The authors noted that none of the gene-expression (microarray) prognostic findings had been validated by other investigators.

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, Asbestos Exposure, Multimodal Therapy, Chemotherapy.

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