Current issues in malignant pleural mesothelioma evaluation and management

Our plain-English summary of Current issues in malignant pleural mesothelioma evaluation and management, by J. Ai, J.P. Stevenson (The Oncologist, 2014).

The study

• Authors: J. Ai, J.P. Stevenson
• Journal: The Oncologist
• Published: 2014;19(9):975-84
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer.

©AlphaMed Press.

In plain English

This article was a narrative review of published research on malignant pleural mesothelioma (MPM), covering its causes, diagnosis, surgery, combined treatments, chemotherapy and experimental drugs. It did not study new patients. The authors described occupational asbestos exposure as the single most important risk factor. They cited an estimated U.S. incidence of 1 in every 100,000, or about 3,000 new cases a year. They also cited earlier work putting the lifetime risk among asbestos workers as high as 10%, with a latency of at least 20–30 years. They noted that no randomized trials had compared the two main operations, extrapleural pneumonectomy and extended pleurectomy/decortication. Citing a phase III trial of 456 patients, they reported overall survival of 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone. They described the cisplatin-antifolate combination as the standard first-line treatment. They stated that no trials of second- or third-line treatment had shown a survival benefit. The authors concluded that MPM remains a highly lethal disease that is rarely cured, and that only a small percentage of fit patients with good prognostic factors may benefit from multimodality therapy.

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 new patients were studied. The review covered published studies and trials on malignant pleural mesothelioma: its epidemiology, diagnosis, staging, surgery, multimodality therapy, chemotherapy, targeted therapy and immunotherapy.
• Exposure: Not an exposure study. The review described occupational asbestos exposure as the single most important risk factor for MPM. It listed uses in cement, ceiling and pool tiles, automobile brake linings and shipbuilding, and did not name fiber types. It also mentioned second-hand exposure of family members, nonoccupational exposure, ionizing radiation, Simian virus 40 and BAP1 inactivation as possible factors.
• Main results:
  • Citing cancer statistics, the authors gave the annual U.S. incidence of MPM as an estimated 1 in every 100,000, with approximately 3,000 new cases per year.
  • Citing earlier work, the authors stated that the lifetime risk of developing MPM among asbestos workers was thought to be as high as 10%.
  • Citing earlier work, the authors described a latency of at least 20–30 years from asbestos exposure to the development of mesothelioma.
  • The authors stated that there were no randomized comparisons of extrapleural pneumonectomy and pleurectomy/decortication.
  • The review described a phase III trial (EMPHACIS, Vogelzang et al.) in which 456 patients were randomized to pemetrexed plus cisplatin or to cisplatin alone.
  • In that trial, overall survival was 12.1 months in the pemetrexed plus cisplatin group versus 9.3 months in the cisplatin-alone group.
  • The authors stated that the cisplatin-antifolate combination is currently considered standard of care as first-line treatment.
  • The authors stated that no trials in the second- or third-line setting had shown a survival benefit.
  • The authors stated that only a small percentage of fit patients with good prognostic factors may benefit from multimodality therapy.
• The authors' conclusion: The authors concluded that, despite advances in surgery, radiation and chemotherapy, MPM remains a highly lethal disease that is rarely cured. They said that only a small percentage of fit patients may benefit from multimodality therapy. They expressed confidence that targeted agents now being tested may lead to effective therapies.

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, Asbestos Exposure, Prognosis, Extrapleural Pneumonectomy (EPP), Surgical Resection, Pemetrexed (Alimta), Chemotherapy, Unresectable.

Related studies

• Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies — M. Pistolesi, J. Rusthoven (2004)
• Malignant pleural mesothelioma: current concepts in treatment — A. Tsiouris, R.K. Walesby (2007)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)
• Combined chemotherapy with cytotoxic and targeted compounds for the management of human malignant pleural mesothelioma — R.E. Favoni, T. Florio (2011)
• Combined FDG-PET/CT in response evaluation of malignant pleural mesothelioma — P. Veit-Haibach, N.G. Schaefer, et al. (2010)
• Optimal management of malignant mesothelioma after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and postoperative radiation — E.R. Sauter, C. Langer, et al. (1995)

Browse more research in The Oncologist, or return to medical research.