Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma

Our plain-English summary of Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma, by K. Turner, S. Varghese, H.R. Alexander (Journal of the National Comprehensive Cancer Network, 2012).

The study

• Authors: K. Turner, S. Varghese, H.R. Alexander
• Journal: Journal of the National Comprehensive Cancer Network
• Published: 2012;10(1):49-57
• Type of article: Review
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and ultimately fatal cancer that was first recognized and described a century ago. It is a diffuse primary malignant condition arising from the mesothelial lining of the peritoneum, and its natural history is hallmarked by a propensity to progress almost exclusively within the abdominal cavity throughout the entire course of disease. Patients afflicted with DMPM most commonly present with nonspecific abdominal symptoms that lead to diagnosis when the condition is relatively advanced. Historically, median overall survival for patients with DMPM without treatment is very short, averaging 6 months. Systemic chemotherapy using pemetrexed and cisplatin has an overall response rate of approximately 25% and a median overall survival of approximately 1 year. Many institutional reports have shown that in selected patients, operative cytoreduction and hyperthermic intraoperative peritoneal chemotherapy using cisplatin or mitomycin C is associated with long-term survival. Recent studies on the molecular biology of DMPM have yielded new insights relating to the potentially important role of the phosphatidylinositol 3-kinase/mammalian target of rapamycin and epidermal growth factor receptor pathways in this disease, which may translate into new therapeutic options for patients with DMPM.

In plain English

This article was a narrative review of how diffuse malignant peritoneal mesothelioma (DMPM) is diagnosed and treated. It mainly summarized earlier studies; one figure also showed survival curves for 101 patients treated at the NCI in Bethesda. As background, the authors noted that a strong association between asbestos exposure and the disease had been documented for decades. They did not study exposure or name asbestos fiber types. Citing earlier work, the authors reported that untreated patients survived a median of about 6 months. In one cited study, median survival was 8.7 months with pemetrexed alone and 13.1 months with pemetrexed plus cisplatin. In another, pemetrexed plus gemcitabine was followed by a median overall survival of 26.8 months. Another treatment combines surgery to remove visible tumor (CRS) with heated chemotherapy inside the abdomen (HIPEC). For this treatment, a 405-patient registry reported a median survival of 53 months, and single-center series ranged from 34.2 to 92 months. The authors noted the absence of randomized trials. They concluded that CRS and HIPEC was an increasingly used approach for patients whose disease could be removed surgically.

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 on the diagnosis and treatment of diffuse malignant peritoneal mesothelioma. It also includes survival curves for patients treated at the NCI in Bethesda.
• Who was studied: Patients with diffuse malignant peritoneal mesothelioma as described in previously published studies, plus survival curves for 101 patients treated at the NCI in Bethesda, Maryland. As background, the review states that about 400 new cases are diagnosed yearly in the United States.
• Exposure: Not studied. As background, the authors mention an association with asbestos exposure reported in earlier studies, without naming asbestos fiber types. They also mention previous abdominal radiation and the mineral erionite.
• Main results:
  • From earlier reports cited by the authors: median overall survival without treatment averaged about 6 months
  • Jänne et al. (2005, cited): median survival was 8.7 months for patients given pemetrexed alone and 13.1 months for those given pemetrexed with cisplatin
  • Phase II trial of pemetrexed plus gemcitabine (2008, cited), in chemotherapy-naive patients with unresectable disease: median overall survival 26.8 months, estimated 1-year survival 67.5%
  • Multi-institutional registry of 405 patients treated with CRS and HIPEC at 29 centers (cited): median actuarial overall survival 53 months; 1-, 3- and 5-year survival 81%, 60% and 47%
  • Feldman et al. (2003, cited), 49 patients at the NCI treated with CRS and HIPEC with cisplatin: median actuarial overall survival 92 months
  • Figure 3 shows actuarial overall survival curves for 101 patients with DMPM treated with CRS and HIPEC at the NCI in Bethesda. It also shows peritoneal progression-free survival for 100 of them.
  • Across selected single-institution series of CRS and HIPEC, median overall survival ranged from 34.2 to 92 months
  • Reported complication rates for CRS and HIPEC were 15% to 31%; reported mortality rates were 0% to 7%
  • A cited study found EGFR point mutations at an overall frequency of 34% in 29 DMPM tumor samples
• The authors' conclusion: The authors concluded that, for patients whose disease can be surgically removed, CRS and HIPEC is an increasingly used approach, with many centers reporting median overall survivals greater than 4 years. They also stated that it represents the standard of care for selected patients.
• Limitations the authors state:
  • The authors note that no randomized controlled studies have shown the benefit of CRS and HIPEC; the survival data come largely from single-institution studies

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneum, Median Overall Survival, Chemotherapy, Pemetrexed (Alimta), Cisplatin, Cytoreductive Surgery, Mitomycin C.

Related studies

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• Current pathogenetic concepts of diffuse malignant mesothelioma — J.E. Craighead (1987)
• Malignant pleural mesothelioma: current concepts in treatment — A. Tsiouris, R.K. Walesby (2007)
• Surgical treatment of peritoneal carcinomatosis: current treatment modalities — Y. Kulu, B. Müller-Stich, et al. (2014)
• Immunohistochemical Evaluation of Minichromosome Maintenance Protein 7 (MCM7), Topoisomerase IIα, and Ki-67 in Diffuse Malignant Peritoneal Mesothelioma Patients Using Tissue Microarray — M. Deraco, A. Cabras, et al. (2015)
• Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma — H.R. Alexander, D.L. Bartlett, et al. (2013)

Browse more research in Journal of the National Comprehensive Cancer Network, or return to medical research.