Diagnostic and Therapeutic Challenges of Malignant Pleural Mesothelioma

Our plain-English summary of Diagnostic and Therapeutic Challenges of Malignant Pleural Mesothelioma, by J. Moro, S. Sobrero, C.F. Cartia, et al (Diagnostics, 2022).

The study

• Authors: J. Moro, S. Sobrero, C.F. Cartia, S. Ceraolo, R. Rapanà, F. Vaisitti, S. Ganio, F. Mellone, S. Rudella, F. Scopis, D. La Paglia, C.C. Cacciatore, E. Ruffini, F. Leo
• Journal: Diagnostics
• Published: 2022;12(12)
• Type of article: Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare cancer characterized by a very poor prognosis. Exposure to asbestos is the leading cause of malignant pleural mesothelioma. The preinvasive lesions, the mesothelial hyperplasia and its possible evolution are the focus of the majority of the studies aiming to identify the treatable phase of the disease. The role of BAP-1 and MTAP in the diagnosis of mesothelioma in situ and in the prognosis of malignant pleural mesothelioma is the main topic of recent studies. The management of preinvasive lesions in mesothelioma is still unclear and many aspects are the subject of debate. The diagnosis, the disease staging and the accurate, comprehensive assessment of patients are three key instants for an appropriate management of patients/the disease.

In plain English

This article was a review by thoracic surgery authors in Turin, Italy. It presented no new patient data of its own. The authors summarized published work on the genetics, risk factors, diagnosis and treatment of malignant pleural mesothelioma. They focused on early pleural changes called mesothelial hyperplasia and mesothelioma in situ. They described asbestos as the major risk factor and noted a small group of cases that seem unrelated to asbestos. They also reported the claim in earlier literature that crocidolite is the most cancer-causing form of asbestos and chrysotile the least. They reviewed genes such as BAP-1, NF2 and CDKN2A/p16, and how loss of BAP-1 or MTAP helps separate mesothelioma in situ from benign changes. Citing other researchers, they reported that 70% of patients with well-defined mesothelioma in situ might develop mesothelioma during follow-up. The authors suggested that talc pleurodesis could trigger progression of mesothelioma in situ and atypical mesothelial hyperplasia, and said its use in these conditions is still debated. They concluded that many aspects of these preinvasive forms remain unclear and called for future prospective studies.

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 (no original data collected)
• Who was studied: No study population; the article reviewed published research on malignant pleural mesothelioma and its preinvasive lesions
• Exposure: Asbestos was described as the major risk factor (serpentine group: chrysotile; amphibole group: crocidolite, amosite, tremolite, anthophyllite, actinolite). The review also covered non-asbestos factors such as erionite, fluoro-edenite, radiation and multiwalled carbon nanotubes, and the inflammatory effect of talc pleurodesis.
• Main results:
  • Citing the SEER database, the review reported a 2019 incidence of malignant pleural mesothelioma of 0.7 per 100,000 person-years: 0.3 for females and 1.3 for males.
  • The review reported the claim in cited literature that crocidolite is the most oncogenic form of asbestos and chrysotile the least.
  • Citing other work, the review described absence of BAP-1 nuclear protein as a marker for detecting mesothelioma in situ with high specificity (98–100%) but lower sensitivity (60–70%).
  • Citing Churg's work, the review reported that 70% of patients with well-defined mesothelioma in situ might develop malignant pleural mesothelioma during follow-up, usually within 12–92 months of diagnosis.
  • Citing other work, the review reported that VATS biopsy has a sensitivity of 95%, a specificity of 100% and a negative predictive value of 94% for diagnosis.
  • Citing the CheckMate 743 trial in unresectable malignant pleural mesothelioma, the review reported 2-year overall survival of 41% with nivolumab plus ipilimumab vs. 27% with platinum plus pemetrexed chemotherapy.
  • The authors suggested that talc pleurodesis, an accepted palliative treatment for mesothelioma, could trigger progression of mesothelioma in situ and atypical mesothelial hyperplasia, and that its use in these conditions is still debated.
• The authors' conclusion: The authors concluded that many aspects of the preinvasive forms (mesothelioma in situ and atypical mesothelial hyperplasia) are still unclear. They said future prospective studies should focus on these lesions and how they progress to malignancy.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Reactive Mesothelial Hyperplasia, MTAP, Mesothelioma in Situ, Mesothelioma, Staging.

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