Epidemiology, diagnosis and treatment of the malignant pleural mesothelioma, a narrative review of literature

Our plain-English summary of Epidemiology, diagnosis and treatment of the malignant pleural mesothelioma, a narrative review of literature, by S.O. Schumann, G. Kocher, F. Minervini (Journal of Thoracic Disease, 2021).

The study

• Authors: S.O. Schumann, G. Kocher, F. Minervini
• Journal: Journal of Thoracic Disease
• Published: 2021;13(4):2510-2523
• Type of article: Review
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The malignant pleural mesothelioma is a very aggressive tumor which is arising from mesothelial cells and is associated with asbestos exposure. It is a heterogeneous cancer that shows a complex pattern of molecular changes, including genetic, chromosomic, and epigenetic abnormalities. The malignant pleural mesothelioma is characterized by a silent and slow clinical progression with an average period of 20-40 years from the asbestos exposure phase to the start of the symptoms. Unfortunately, to date, the therapeutic options are very limited, especially if the tumor is detected late. This narrative review provides an extended overview of the present evidence in the literature regarding the epidemiology, diagnostic pathways and treatment approaches of the malignant pleural mesothelioma. The treatment of mesothelioma has evolved slowly over the last 20 years not only from a surgical point of view but also radiotherapy, chemotherapy and immunotherapy play nowadays a key role. Several surgical strategies are available ranging from extrapleural pneumonectomy to cytoreductive surgery but a multidisciplinary approach seems to be mandatory because a single approach has not proved to date to be resolutive. New non-surgical treatment options appear to be promising but the results have to be taken in account with caution because clear evidence with high-quality studies is still lacking.

2021 Journal of Thoracic Disease. All rights reserved.

In plain English

This article was a narrative review, not a new study. The authors hand-searched PubMed for English-language articles published between 1990 and July 2020 and summarized evidence on the epidemiology, diagnosis and treatment of malignant pleural mesothelioma. The review listed six regulated asbestos fibers: chrysotile, amosite, crocidolite, tremolite, actinolite and anthophyllite. It stated that eighty percent of patients had been directly or indirectly exposed to asbestos, with an estimated latency of 20 to 40 years. Among studies it cited, a US cancer registry analysis reported median survival of 14 months for epithelioid, 10 for biphasic and 4 for sarcomatoid tumors. In the MARS randomized trial, all patients received chemotherapy. Median survival was 14.4 months (5.3–18.7) in the group assigned to extrapleural pneumonectomy (16 of 24 had it) and 19.5 months (13.4 to beyond the observation period) in the group without it. The authors concluded that a multidisciplinary approach seems mandatory because no single approach has yet proved resolutive, and that patients should, if possible, be treated within study protocols at high-volume centers. They noted that a narrative review likely involves some subjectivity in choosing 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: Narrative review of published literature (hand-searched)
• Who was studied: Published English-language articles found in PubMed on malignant pleural mesothelioma, treatment and surgery, published between 1990 and July 2020; no new patients were studied
• Exposure: Asbestos as the background cause of malignant pleural mesothelioma. The review describes six regulated fibers: the serpentine chrysotile and the amphiboles amosite, crocidolite, tremolite, actinolite and anthophyllite. It states that eighty percent of patients had been directly or indirectly exposed to asbestos fibers. The review's main focus is diagnosis and treatment rather than exposure.
• Main results:
  • Citing earlier sources, the review stated that when untreated, less than 5% of patients survive 5 years, with an average survival of 4–12 months after diagnosis
  • In a cited analysis of the US SEER database (Meyerhoff et al.), patients with known histology from 2004–2010 had these subtypes: epithelioid 811 of 1,183 (69%), sarcomatoid 224 of 1,183 (19%) and biphasic 148 of 1,183 (12%). Median overall survival was 4 months for sarcomatoid, 10 months for biphasic and 14 months for epithelioid tumors.
  • In a cited study (Sugarbaker et al.), multimodal therapy based on extrapleural pneumonectomy was associated with survival of more than 3 years in 18% of patients (117 of 636)
  • In the cited MARS randomized trial, all 112 included patients had platinum-based chemotherapy, and 50 were randomized. Of the 24 assigned to extrapleural pneumonectomy, 16 underwent it. Median survival was 14.4 months (5.3–18.7) in the extrapleural pneumonectomy cohort and 19.5 months (13.4 to beyond the observation time) in the no-extrapleural-pneumonectomy cohort.
  • In the cited MesoVATS trial, 1-year survival was 57% in the talc pleurodesis group and 52% in the video-assisted thoracoscopic partial pleurectomy group. Surgical complications were 14% and 31% respectively.
  • In a cited trial (Vogelzang et al.), platinum plus pemetrexed was compared with cisplatin alone. The combination group had a higher response rate (41.3% vs. 16.7%; P<0.001) and longer median overall survival (12.1 vs. 9.3 months; P=0.020).
• The authors' conclusion: The authors concluded that a multidisciplinary approach seems mandatory because no single approach has yet proved resolutive. They called for further large-scale treatment studies and recommended that patients be treated, if possible, within study protocols at high-volume centers. They also concluded that histological subtype should be part of the therapy concept.
• Limitations the authors state:
  • As a narrative review, the choice of included studies is likely to involve some subjectivity
  • The large number of cited sources involves complex interactions that may be difficult to identify and integrate

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Pleural Mesothelioma, Mesothelial Cells, Asbestos Exposure, Mesothelioma, Chemotherapy, Immunotherapy, Extrapleural Pneumonectomy (EPP).

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