Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies

Our plain-English summary of Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies, by D.A. Mahvi, R. Liu, M.W. Grinstaff, et al (CA: A Cancer Journal for Clinicians, 2018).

The study

• Authors: D.A. Mahvi, R. Liu, M.W. Grinstaff, Y.L. Colson, C.P. Raut
• Journal: CA: A Cancer Journal for Clinicians
• Published: 2018;68(6):488-505
• Type of article: Review
• Cited by: 266 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Locoregional recurrence negatively impacts both long-term survival and quality of life for several malignancies. For appropriate-risk patients with an isolated, resectable, local recurrence, surgery represents the only potentially curative therapy. However, oncologic outcomes remain inferior for patients with locally recurrent disease even after macroscopically complete resection. Unfortunately, these operations are often extensive, with significant perioperative morbidity and mortality. This review highlights selected malignancies (mesothelioma, sarcoma, lung cancer, breast cancer, rectal cancer, and peritoneal surface malignancies) in which surgical resection is a key treatment modality and local recurrence plays a significant role in overall oncologic outcome with regard to survival and quality of life. For each type of cancer, the current, state-of-the-art treatment strategies and their outcomes are assessed. The need for additional therapeutic options is presented given the limitations of the current standard therapies. New and emerging treatment modalities, including polymer films and nanoparticles, are highlighted as potential future solutions for both prevention and treatment of locally recurrent cancers. Finally, the authors identify additional clinical and research opportunities and propose future research strategies based on the various patterns of local recurrence among the different cancers.

© 2018 American Cancer Society.

In plain English

This was a review. The authors described current ways to prevent and treat local recurrence (cancer returning at or near its original site after surgery) in six cancers, including malignant pleural mesothelioma and peritoneal surface malignancies such as peritoneal mesothelioma. Asbestos appeared only in the statement that pleural mesothelioma is mostly related to asbestos exposure. For pleural mesothelioma, the review cited earlier studies reporting median survival of 9 to 12 months with supportive care alone. It also cited local recurrence rates of 65% after pleurectomy/decortication versus 33% after extrapleural pneumonectomy, with similar survival. For peritoneal mesothelioma, it cited a meta-analysis of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy reporting 84% one-year survival. The authors described experimental drug-delivery methods such as nanoparticles and polymer films, including their own group's mouse experiments in peritoneal mesothelioma. They noted that most of these methods remain in preclinical testing. The authors concluded that local drug-delivery platforms will be one of the next frontiers for reducing local recurrence.

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
• Who was studied: No study population of its own; the review covered published research on six cancers: rectal cancer, breast cancer, mesothelioma, non-small cell lung cancer, retroperitoneal sarcoma and peritoneal surface malignancies
• Exposure: Not an exposure study. Asbestos is mentioned only in passing: the review states that malignant pleural mesothelioma is mostly related to asbestos exposure. No fiber types, products, jobs or doses are discussed.
• Main results:
  • Malignant pleural mesothelioma: median overall survival of 9 to 12 months with supportive care alone (as cited from earlier literature)
  • Sarcomatoid pleural mesothelioma: median overall survival of 8 months (HR, 1.70; P < .0001), as cited from earlier literature
  • Pleural mesothelioma surgery: compared with extrapleural pneumonectomy, pleurectomy/decortication was associated with similar survival but significantly higher local recurrence (65% vs 33%), as cited from a prior study
  • Pleural mesothelioma: in a cited phase 2 trial of 92 patients who had extrapleural pneumonectomy plus heated intraoperative chemotherapy with cisplatin, sodium thiosulfate and amifostine, the local recurrence rate was 17%
  • Pleural mesothelioma: in a cited phase 3 trial of 456 patients with unresectable disease, cisplatin plus pemetrexed gave a higher response rate than cisplatin alone (41% vs 17%)
  • Peritoneal mesothelioma: a cited meta-analysis of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy reported 84% 1-year survival and 42% overall survival (at 5 years, per the continuation after a table break)
  • The authors' own group reported that paclitaxel-loaded expansile nanoparticles delivered into the abdomen decreased recurrence and improved survival in mouse models of peritoneal mesothelioma (animal experiments, cited)
• The authors' conclusion: The authors concluded that local drug-delivery platforms will be one of the next frontiers for reducing local recurrence while minimizing systemic side effects, and that further research on safety and efficacy is needed.
• Limitations the authors state:
  • Most of the novel drug-delivery platforms described have been tested only in preclinical studies.
  • For peritoneal surface malignancies, randomized trial data on adding hyperthermic intraperitoneal chemotherapy to cytoreductive surgery are lacking, and its added benefit is uncertain.

Topics

Medical terms in this study, explained in our Lexicon: Quality of Life, Mesothelioma, Sarcoma, Lung Cancer, Surgical Resection.

Related studies

• Percutaneous Cryoablation for the Treatment of Recurrent Malignant Pleural Mesothelioma: Safety, Early-Term Efficacy, and Predictors of Local Recurrence — F. Abtin, M.T. Quirk, et al. (2017)
• Local recurrence model of malignant pleural mesothelioma for investigation of intrapleural treatment — I. Opitz, D. Lardinois, et al. (2007)
• Bioluminescence imaging for in vivo monitoring of local recurrence mesothelioma model — Y. Shi, A. Hollenstein, et al. (2011)
• Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence? — S. Bölükbas, M. Eberlein, et al. (2013)
• Local recurrence of lung adenocarcinoma 10 years after left upper lobectomy resembling pseudomesotheliomatous adenocarcinoma: a case report — J. Okamoto, H. Kubokura, et al. (2014)
• Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence? — D. Gomez, A. Tsao, et al. (2013)

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