Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma

Our plain-English summary of Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma, by A. Scherpereel, French Speaking Society for Chest Medicine (SPLF) Experts Group (Respiratory Medicine, 2007).

The study

• Authors: A. Scherpereel, French Speaking Society for Chest Medicine (SPLF) Experts Group
• Journal: Respiratory Medicine
• Published: 2007;101(6):1265-76
• Type of article: Consensus statement, Guideline
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Previously considered as a rare tumor, malignant pleural mesothelioma (MPM) has become a very important public health issue. In fact, MPM is a tumor with a poor survival, and its incidence is expected to continue to increase for at least the next 10 years. Asbestos exposure is the main factor involved in MPM pathogenesis. The diagnosis of MPM may be difficult because of differential diagnosis such as pleural benign disease induced by asbestos exposure or pleural metastasis of adenocarcinoma. Management of patients with MPM also remains complicated because they are often referred for evaluation late in the evolution of the disease. Moreover, MPM exhibits a high resistance to radiotherapy and chemotherapy; only few patients are candidates for radical surgery. New therapeutic strategies such as gene or cell therapy are still on clinical trial. Therefore, an optimal treatment of MPM is not clearly defined yet, despite the introduction of recent drugs. Between April 2005 and January 2006, the French Speaking Society for Chest Medicine (SPLF), in collaboration with other French scientific societies, brought together experts on mesothelioma to draw up recommendations in order to provide clinicians with clear, concise, up-to-date guidelines on management of MPM, presented in this report.

In plain English

This article was a clinical guideline, not a study of patients. From April 2005 to January 2006, the French Speaking Society for Chest Medicine and three other French societies held an expert conference on malignant pleural mesothelioma. The experts searched literature databases, graded recommendations by evidence strength, and revised proposals that fewer than 85% fully agreed with. The guideline named asbestos the main cause, with no identified threshold below which risk does not increase, making exposed people the main at-risk group. It recommended an occupational and environmental exposure history for every patient, called measuring asbestos in body samples not routinely essential, and said screening's value has not been demonstrated. It recommended thoracoscopy for diagnosis unless contraindicated or prevented by pleural symphysis, always with immunohistochemistry. Chemotherapy should be decided case by case, considering performance status and other illnesses, with cisplatin plus pemetrexed or raltitrexed first-line. It recommended extrapleural pneumonectomy only within clinical trials, and offering all patients in France a FIVA compensation claim. The authors noted the literature is poor on many aspects of mesothelioma.

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: Clinical practice guideline produced by an expert conference (chosen instead of a consensus conference). It was based on a systematic literature search. Each recommendation was graded by level of evidence and voted on by the experts, and a proposal was revised if fewer than 85% of experts fully agreed with it.
• Who was studied: Experts on mesothelioma from four French scientific societies (chest medicine, pathology, thoracic and cardiovascular surgery, occupational medicine), meeting between April 2005 and January 2006. The guideline covers the management of patients with malignant pleural mesothelioma (MPM).
• Exposure: Asbestos exposure and how to evaluate it. The guideline named asbestos and erionite as the two clearly established risk factors for MPM. It noted that chrysotile and amphibole asbestos may differ in pleural carcinogenicity, but that current exposure questionnaires cannot tell exposure to the two apart.
• Main results:
  • The guideline stated that a dose-effect relationship has been shown for asbestos, but no threshold cumulative exposure level without increased risk has been identified. It recommended targeting asbestos-exposed individuals as the main at-risk population (grade A).
  • An occupational and environmental exposure history was recommended as the fundamental tool to determine asbestos exposure, to be used for every patient with MPM (grade A).
  • Measuring asbestos bodies or fibres in biological samples (biometrology) was described as not essential in current clinical practice. A negative result does not rule out exposure sufficient to cause mesothelioma.
  • The value of screening for mesothelioma had not been demonstrated. Biological markers were not recommended for screening, even in asbestos-exposed populations, outside research programmes (grade A).
  • Thoracoscopy was recommended for diagnosis except in case of preoperative contraindication or pleural symphysis (grade A).
  • A diagnosis of MPM should always be based on immunohistochemical examination (grade A).
  • Patients over 18 in good performance status (0 or 1) were described as likely to benefit from chemotherapy. The indications depend on comorbidities and the wishes of the patient and family. The decision should be discussed case by case in a multidisciplinary meeting (grade A).
  • Cisplatin combined with pemetrexed or raltitrexed was recommended as first-line chemotherapy (grade A). No chemotherapy was recommended as second-line after failure of cisplatin-containing treatment.
  • Extrapleural pneumonectomy was recommended only within clinical trials, because results of feasibility studies and randomised trials were lacking (grade A).
  • In France, a request for compensation from FIVA (the national compensation fund for asbestos victims) should be proposed for all patients, whether or not asbestos exposure has been identified and whatever its source (grade A).
• The authors' conclusion: The authors concluded that the expert conference provided guidelines on MPM management for clinicians and patients, including the latest diagnostic and therapeutic tools available in 2005. They added that it aimed to stimulate collaboration among those involved in MPM management, including research laboratories.
• Limitations the authors state:
  • The authors stated that the guidelines do not answer all unresolved questions, because the literature is poor on many aspects of mesothelioma.
  • The authors stated that the role of treatment was not fully addressed, as no publication yet fully answers this question.

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, Asbestos Exposure, Differential Diagnosis, Metastasis, Adenocarcinoma, Chemotherapy, Clinical Trial, Mesothelioma.

Related studies

• Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma — A. Scherpereel, P. Astoul, et al. (2010)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines — A.M. Schwartz, M.K. Rezaei (2013)
• 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)
• Society of Behavioral Medicine (SBM) position statement: ban indoor tanning for minors — S. Pagoto, J. Hillhouse, et al. (2014)
• Position Paper on Asbestos of the Italian Society of Occupational Medicine — P. Apostoli, P. Boffetta, et al. (2019)

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