Future developments in the management of malignant pleural mesothelioma

Our plain-English summary of Future developments in the management of malignant pleural mesothelioma, by P.A. Zucali, F. De Vincenzo, M. Simonelli, et al (Expert Review of Anticancer Therapy, 2009).

The study

• Authors: P.A. Zucali, F. De Vincenzo, M. Simonelli, A. Santoro
• Journal: Expert Review of Anticancer Therapy
• Published: 2009;9(4):453-67
• Type of article: Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive tumor with a poor prognosis and an increasing incidence as a result of widespread exposure to asbestos. In the past few years, there have been several developments in the management of patients with MPM, including more accurate staging and patient selection, improvements in surgical techniques and postoperative care, novel chemotherapy regimens and new radiotherapy techniques. However, chemotherapy remains the mainstay of treatment, considering that surgery and radiotherapy have a limited role in highly selected patients, and its results are still modest, with a median survival of approximately 1 year. The principal goals of this review are to summarize the improvements in the management of MPM that have been achieved recently and to outline the therapeutic approaches in development.

In plain English

This article was a review, not an original study. The authors summarized published research on diagnosing, staging and treating malignant pleural mesothelioma, and on treatments then under development. The review stated that about 80% of cases can be attributed to asbestos fiber exposure. It did not itself study asbestos exposure. Several studies it described illustrate the evidence. In a trial of 448 patients who had not had chemotherapy before, those given pemetrexed plus cisplatin had a median overall survival of 12.1 months, against 9.3 months with cisplatin alone. In a surgical series, stage I and II patients had a median survival of 23 months after pleurectomy/decortication (98 patients) and 19 months after extrapleural pneumonectomy (96 patients). That difference was not statistically significant (p = 0.07). Targeted drugs such as gefitinib and imatinib showed minimal or no activity in early trials. The authors concluded that surgery and radiotherapy have a limited role in highly selected patients, and that chemotherapy results remain modest, with a median survival of about one year. They also concluded that a better understanding of the tumor's molecular biology may lead to biomarkers and new targeted treatments.

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 research on the management of malignant pleural mesothelioma
• Who was studied: No study population of its own; the review covers published studies of patients with malignant pleural mesothelioma
• Exposure: The review is about diagnosis and treatment (surgery, radiotherapy, chemotherapy, targeted drugs), not exposure. It states that about 80% of cases can be attributed to asbestos fiber exposure. No fiber types are named.
• Main results:
  • In a Phase III trial cited by the review (448 chemonaive patients), median overall survival was 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone
  • In a cited multicenter surgical study, stage I and II patients had a median survival of 23 months after pleurectomy/decortication (n = 98) versus 19 months after extrapleural pneumonectomy (n = 96), p = 0.07, described as no significant difference
  • In a cited Phase III trial of second-line pemetrexed versus best supportive care, time to progression improved significantly (3.8 vs 1.5 months), but overall survival did not
  • In a cited randomized Phase II trial of 108 patients, adding bevacizumab to gemcitabine plus cisplatin gave progression-free survival of 6.9 months versus 6.0 months with placebo (HR = 0.93; p = 0.88)
  • In a cited cohort of 137 patients who had PET scans, the relative risk of death for a standardized uptake value greater than 10, compared with less than 10, was 3.3 (p = 0.03)
  • Cited trials of EGFR inhibitors (two of gefitinib, one of erlotinib) showed minimal activity
  • Cited early trials of imatinib failed to achieve any responses in four Phase II trials
• The authors' conclusion: The authors concluded that surgery and radiotherapy have a limited role in highly selected patients. They found chemotherapy results still modest, with a median survival of about one year. They expected better knowledge of the molecular changes in the tumor to yield biomarkers and new targeted agents.
• Limitations the authors state:
  • The authors note that the low incidence of the disease has made adequately sized randomized controlled studies difficult to conduct (a limitation of the evidence reviewed)
  • The authors note that surgical results are hard to interpret because of differing patient selection, small patient numbers and lack of randomized trials

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Staging, Chemotherapy, Median Survival.

Related studies

• Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma — B. Woods, N. Paracha, et al. (2012)
• Systemic treatment of malignant pleural mesothelioma — F. Grosso, G.V. Scagliotti (2012)
• In Australia, patients and government at odds over mesothelioma treatment costs — V. Burkitt (2007)
• Vinca alkaloids in the therapeutic management of malignant pleural mesothelioma — G.L. Ceresoli, P.A. Zucali (2015)
• Multicenter randomized controlled trial of the management of unresectable malignant mesothelioma proposed by the British Thoracic Society and the British Medical Research Council — D.J. Girling, M.F. Muers, et al. (2002)
• Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy — G. Toyokawa, M. Takenoyama, et al. (2014)

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