How I treat malignant pleural mesothelioma

Our plain-English summary of How I treat malignant pleural mesothelioma, by G. Viscardi, R. Di Liello, F. Morgillo (ESMO Open, 2020).

The study

• Authors: G. Viscardi, R. Di Liello, F. Morgillo
• Journal: ESMO Open
• Published: 2020;4(Suppl 2):e000669
• Type of article: Review
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare and aggressive malignancy mostly associated with occupational asbestos exposure. Prognosis is poor and only highly selected patients may benefit from aggressive surgical management, also as part of a multimodal approach. In advanced disease, the combination of pemetrexed and platinum remains the only established treatment, while efficacy evidence of second line chemotherapy is lacking. Thus, a deeper knowledge of biology of the disease and more effective treatments are urgently needed. Refer to specialised centres with multidisciplinary expertise is mandatory, as well as inclusion of patients in clinical trials is advisable whenever possible. In all stages of disease focus on symptoms control is paramount.

© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ on behalf of the European Society for Medical Oncology.

In plain English

This article is a short review by authors from a medical oncology department at a university in Naples, Italy, describing how they approach the treatment of malignant pleural mesothelioma. It reports no new patient data of its own; it summarises published studies. The authors noted that the disease is linked to occupational asbestos exposure in almost 80% of cases. They described surgery as an option only for highly selected patients. They noted that a randomised trial (MARS 1) did not show a survival or quality-of-life benefit from extrapleural pneumonectomy, as part of three-part treatment, compared with chemotherapy alone. For disease that cannot be removed, they described pemetrexed with cisplatin as the standard first treatment. They cited an earlier trial in which median overall survival was 12.1 months with the combination versus 9.3 months with cisplatin alone. They stated that no standard second-line treatment exists and that no markers predicting response to immunotherapy had been defined. The authors concluded that patients should be referred to specialised multidisciplinary centres and offered clinical trials where possible, and that symptom control is paramount at all stages.

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 ("How I treat" article) summarising published studies; no original data
• Who was studied: No study population of its own; the review discusses published research on patients with malignant pleural mesothelioma
• Exposure: Asbestos exposure was not studied. The article states as background that malignant pleural mesothelioma is linked to occupational asbestos exposure, which accounts for almost 80% of cases. No fiber types are named. The subject of the review is treatment (surgery, chemotherapy, radiotherapy, immunotherapy, palliative care).
• Main results:
  • The authors stated that only highly selected patients may benefit from aggressive surgery.
  • Citing the MARS 1 randomised trial (not this article's own study), the authors reported that it did not show a benefit for survival or quality of life from extrapleural pneumonectomy within trimodal therapy over chemotherapy alone.
  • Citing the trial by Vogelzang et al (not this article's own study), the authors reported median overall survival of 12.1 months in the pemetrexed/cisplatin arm versus 9.3 months with cisplatin alone (p=0.020).
  • The authors stated that, based on the trials they reviewed, current data do not support any maintenance therapy for unresectable disease after induction chemotherapy.
  • Citing the SMART trial, the authors stated that routine prophylactic radiotherapy for all patients is not recommended.
  • The authors stated that nearly all patients progress during or after first-line therapy and that no standard second-line treatment exists.
  • The authors stated that no predictive biomarkers of response to immune checkpoint inhibitors have been defined.
• The authors' conclusion: The authors concluded that patients should be referred to specialised centres with multidisciplinary expertise, that inclusion in clinical trials is advisable whenever possible, and that focus on symptom control is paramount at all stages of disease.

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: Pleural Mesothelioma, Asbestos Exposure, Prognosis, Pemetrexed (Alimta), Chemotherapy, Clinical Trial.

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