Diffuse malignant peritoneal mesothelioma: A review

Our plain-English summary of Diffuse malignant peritoneal mesothelioma: A review, by L. Sun, C. Li, S. Gao (Frontiers in Surgery, 2022).

The study

• Authors: L. Sun, C. Li, S. Gao
• Journal: Frontiers in Surgery
• Published: 2022;9:1015884
• Type of article: Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse malignant peritoneal mesothelioma (DMPM) is an unusual and life-threatening locally invasive tumor. The morbidity and mortality of the disease are associated with progressive local effects in the abdominal cavity, such as abdominal distention, painful sensations, and early saturation with reduced oral intake, which eventually lead to intestinal obstruction and cachexia. Computed tomography (CT) has been widely used as a first-line diagnostic tool for DMPM. In addition, the most sensitive immunohistochemical markers of DMPM include WT 1, D2-40, and calmodulin. This paradigm has altered with the advancements in the immunohistochemical analysis of BRCA1-Associated Protein 1 (BAP1) the lack of BAP1 expression shows the diagnosis of malignancy. DMPM is resistant to conventional chemotherapies. Therefore, the gold standard for the treatment of DMPM is the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The overexpression of the phosphatidylinositol 3-kinase (PI3K)/AKT serine/threonine kinase 1 (AKT)/mammalian target of rapamycin (mTOR) signaling pathway drives the malignant phenotype of DMPM, thereby showing promising potential for the treatment of DMPM. The coordinated activities among multiple RTKs are directly involved in the biological processes of DMPM, suggesting that the combined inhibition of the PI3K and mTOR signaling pathways might be an effective measure. This treatment strategy can be easily implemented in clinical practice. However, the combined inhibition of ERBB1(HER1)/ERBB2 (HER2) and ERBB3 (HER3) requires further investigations. Thus, based on these, the discovery of novel targeted therapies might be crucial to improving the prognosis of DMPM patients.

© 2023 Sun, Li and Gao.

In plain English

This article was a narrative review of published work on diffuse malignant peritoneal mesothelioma (DMPM), a cancer of the lining of the abdomen. The three authors were based at China-Japan Union Hospital in Changchun, China. It reported no new patient data and did not describe how the studies it covered were chosen. Citing other studies, the review stated that DMPM accounts for 7%–30% of mesotheliomas and that about one-third of DMPM patients have a history of asbestos exposure. It said asbestos has a weak correlation with DMPM but is considered one of its high-risk factors, and it gave a latency of about 40–50 years from asbestos exposure to disease. The review also covered symptoms, staging, imaging, tissue diagnosis and treatment. For combined surgery to remove visible tumor plus heated chemotherapy inside the abdomen (CRS and HIPEC), it cited median overall survival of 38.4 to 63.2 months and five-year survival of 39.0% to 91.3%. The authors concluded that some patients might benefit from this combination and that new targeted therapies might be crucial. The text contains apparent errors in some figures and citations.

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 (no original data; search methods not described)
• Who was studied: No study population of its own; the review covered published research on diffuse malignant peritoneal mesothelioma (DMPM)
• Exposure: Asbestos exposure discussed as a risk factor for DMPM (no fiber types specified); other factors listed include zeolite, xylene, mica, talcum powder, chronic peritonitis and therapeutic radiation
• Main results:
  • Citing other work, the review stated that DMPM accounts for 7%–30% of mesotheliomas
  • The review described asbestos as having a weak correlation with DMPM while still being considered one of its high-risk factors
  • Citing US data, the review gave a median age at diagnosis of 63.3 years and a latency of about 40–50 years from asbestos exposure to disease
  • The review stated that males are more likely to develop pleural mesothelioma and females more likely to develop DMPM
  • The review noted that researchers have recommended annual abdominal ultrasonography for people with a history of asbestos exposure, because no screening program for DMPM exists
  • The review stated that DMPM was once considered an end-stage disease with median overall survival of only 6 to 12 months after diagnosis
  • For combined CRS and HIPEC, the review cited median overall survival of 38.4 to 63.2 months, five-year survival of 39.0% to 91.3%, and perioperative mortality of 0 to 6%
  • Citing a phase II trial, the review reported that pemetrexed combined with gemcitabine extended median overall survival of DMPM patients to 26.8 months
• The authors' conclusion: The authors concluded that some patients might benefit from combined CRS and HIPEC, that complete CRS indicates a good prognosis, and that discovering new targeted therapies might be crucial to improving the prognosis of DMPM patients
• Limitations the authors state:
  • The authors noted that epidemiological studies of DMPM in China are limited
  • The authors noted that clinical trials of systemic therapy for DMPM are limited
  • The authors stated that further studies are needed on the efficacy of immunotherapy for DMPM

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cachexia, Podoplanin (D2-40), BAP1, Cytoreductive Surgery, HIPEC, HER2, Discovery.

Related studies

• Prognostic role of CD74, CD10 and Ki-67 immunohistochemical expression in patients with diffuse malignant peritoneal mesothelioma: a retrospective study — Y. Liang, C. Li, et al. (2023)
• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• Diffuse malignant peritoneal mesothelioma--an update on treatment — P. Mirarabshahii, K. Pillai, et al. (2012)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)

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