Diffuse pulmonary malignant mesothelioma: response to doxorubicin and 5-azacytidine

Our plain-English summary of Diffuse pulmonary malignant mesothelioma: response to doxorubicin and 5-azacytidine, by A.P. Chahinian, Y. Suzuki, E.M. Mandel, et al (Cancer, 1978).

The study

• Authors: A.P. Chahinian, Y. Suzuki, E.M. Mandel, J.F. Holland
• Journal: Cancer
• Published: 1978;42(4):1687-91
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy.

Abstract

A 46-year-old patient who developed a right pleural mesothelioma 18 years after asbestos exposure was found to have diffuse reticular nodular infiltrates in both lungs. Lung biopsy by fiberoptic bronchoscopy revealed alveolar and interstitial spread of the neoplastic cells. A dramatic clinical and radiologic response occurred after treatment with a combination of doxorubicin (Adriamycin) and 5-Azacytidine.

In plain English

This was a case report of a 46-year-old fuel-retailer admitted to Mount Sinai Hospital in September 1976 with right pleural mesothelioma. He had been exposed to asbestos for 5 years from age 25 as a boiler cleaner and repairman. No fiber type was named. His mesothelioma was confirmed after surgery in December 1973, followed by radiotherapy. In 1976 his chest x-ray showed a diffuse reticular nodular pattern in both lungs. Biopsies showed mesothelioma cells spreading into the lung, replacing the cells lining the air sacs, without asbestosis. From October 1976 he received monthly doxorubicin (Adriamycin) and 5-azacytidine. His breathlessness improved within 2 weeks, and he returned to full-time work. Repeat x-rays showed the lung infiltrate had cleared completely, and his blood oxygen rose from 44 to 84 mm Hg. Side effects included hair loss. After 14 courses, with doxorubicin later replaced by cyclophosphamide, he was described as totally asymptomatic. The authors called the response remarkable. They called these preliminary results, with further assessment in progress: two of eight patients at their institution, including this one, had complete responses.

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: case report (single patient)
• Who was studied: One 46-year-old white male fuel-retailer with right pleural mesothelioma, admitted to Mount Sinai Hospital in September 1976
• Exposure: Occupational asbestos exposure for 5 years starting at age 25, working as a boiler cleaner and repairman. No fiber type was stated.
• Main results:
  • Tubulo-papillary mesothelioma was confirmed after surgery in December 1973. The patient then received 20 sessions of radiotherapy.
  • Biopsy taken by fiberoptic bronchoscopy showed tumor cells replacing the cells lining the air sacs of the lung.
  • The lung biopsy showed tumor infiltration without granulomas or asbestosis.
  • No ferruginous (asbestos) bodies were seen in the sections examined. The authors said this was not surprising.
  • After doxorubicin and 5-azacytidine treatment began in October 1976, the patient's shortness of breath improved within 2 weeks.
  • Repeat chest x-rays showed complete clearing of the reticular nodular infiltrate.
  • Arterial blood oxygen (pO2) was 44 mm Hg on admission before chemotherapy and 84 mm Hg in February 1977. The OCR reads the second value as 'PO,'; it is pO2.
  • Side effects were hair loss and a lowest white blood cell count of 3,300/mm3. Transient sleepiness also occurred after the second course.
  • Adriamycin (doxorubicin) was stopped after a total cumulative dose of 550 mg/m2 and replaced by cyclophosphamide 200 mg/m2 by vein daily for 3 days.
  • After 14 courses, the patient was described as free of symptoms.
  • The authors reported preliminary results from their institution. Among eight patients with diffuse malignant mesothelioma, two had complete objective responses, lasting 18+ and 19+ months, and one of these was this patient.
• The authors' conclusion: The authors described the patient's clinical and x-ray response to doxorubicin and continuous-infusion 5-azacytidine as remarkable. They said further assessment of this therapy was in progress at their institution.

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: Malignant Mesothelioma, Doxorubicin, Pleural Mesothelioma, Asbestos Exposure, Biopsy, Bronchoscopy, Interstitial.

Related studies

• The value of adriamycin in the treatment of diffuse malignant pleural mesothelioma — B.S. Yap, R.S. Benjamin, et al. (1978)
• High liposomal doxorubicin tumour tissue distribution, as determined by radiopharmaceutical labelling with (99m)Tc-LD, is associated with the response and survival of patients with unresectable pleural mesothelioma treated with a combination of liposomal doxorubicin and cisplatin — O. Arrieta, L.A. Medina, et al. (2014)
• Extracellular signal-regulated kinase 5 and cyclic AMP response element binding protein are novel pathways inhibited by vandetanib (ZD6474) and doxorubicin in mesotheliomas — M. Sayan, A. Shukla, et al. (2014)
• Valproate-doxorubicin: promising therapy for progressing mesothelioma. A phase II study — A. Scherpereel, T. Berghmans, et al. (2011)
• Pharmacokinetics of doxorubicin and cisplatin used in intraoperative hyperthermic intrathoracic chemotherapy after cytoreductive surgery for malignant pleural mesothelioma and pleural thymoma — S. van Ruth, O. van Tellingen, et al. (2003)
• Microspheres targeted with a mesothelin antibody and loaded with doxorubicin reduce tumor volume of human mesotheliomas in xenografts — S.L. Macura, J.L. Steinbacher, et al. (2013)

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