Malignant mesothelioma

Our plain-English summary of Malignant mesothelioma, by B.W. Robinson, A.W. Musk, R.A. Lake (Lancet, 2005).

The study

• Authors: B.W. Robinson, A.W. Musk, R.A. Lake
• Journal: Lancet
• Published: 2005;366(9483):397-408
• Type of article: Review
• Cited by: 605 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is an aggressive, treatment-resistant tumour, which is increasing in frequency throughout the world. Although the main risk factor is asbestos exposure, a virus, simian virus 40 (SV40), could have a role. Mesothelioma has an unusual molecular pathology with loss of tumour suppressor genes being the predominant pattern of lesions, especially the P16INK4A, and P14ARF, and NF2 genes, rather than the more common p53 and Rb tumour suppressor genes. Cytopathology of mesothelioma effusions or fine-needle aspirations are often sufficient to establish a diagnosis, but histopathology is also often required. Patients typically present with breathlessness and chest pain with pleural effusions. Median survival is now 12 months from diagnosis. Palliative chemotherapy is beneficial for mesothelioma patients with high performance status. The role of aggressive surgery remains controversial and growth factor receptor blockade is still unproven. Gene therapy and immunotherapy are used on an experimental basis only. Patterns identified from microarray studies could be useful for diagnosis as well as prognostication.

In plain English

This article was a review (a Lancet 'Seminar') of malignant mesothelioma, not a new study of patients. The authors searched PubMed for English-language publications from the previous 15 years. They summarised what was known about the disease's causes, biology, diagnosis, treatment and prevention. They described asbestos as the main cause, with an incubation period typically longer than 30 years, and said any role for the virus SV40 remained unclear and unproven. They gave median survival from presentation as 9–12 months. The review also reported findings from earlier studies. In one study of 44 mesothelioma patients, 84% had raised blood levels of a marker called SMRP, compared with fewer than 2% of patients with other pleural or lung diseases. In a phase III trial in 448 patients, pemetrexed plus cisplatin improved overall survival by nearly 3 months compared with cisplatin alone. The authors called the role of radical surgery controversial. The authors concluded that, for patients with good performance status, they considered pemetrexed and cisplatin the standard first-line palliative chemotherapy.

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 (Lancet Seminar) based on a PubMed literature search
• Who was studied: No patients were studied directly; the review covered English-language publications from the past 15 years found on PubMed, plus citations from those papers and selected websites
• Exposure: Asbestos as the main cause of mesothelioma. Crocidolite is mentioned as the most durable commercial form. Other recognised causes named are erionite exposure in Turkey, ionising radiation (thorotrast) and chest injuries; SV40 virus is discussed as a possible cofactor.
• Main results:
  • The review gave median survival from presentation as 9–12 months
  • The review reported that the incubation period after first exposure is typically longer than 30 years, although periods of around 15 years have been described
  • The review stated that mesothelioma risk is virtually zero for the first 10–15 years after first exposure and then progressively increases with time
  • The review reported that up to 60% of human mesotheliomas contain SV40 DNA, but described any role for SV40 as unclear and unproven
  • In a cited study of 44 mesothelioma patients, 84% had elevated SMRP, compared with fewer than 2% of patients with other pleural or pulmonary inflammatory or malignant diseases
  • In a cited multicentre phase III study in 448 patients, pemetrexed plus cisplatin improved overall survival by nearly 3 months compared with cisplatin alone, with an objective response rate of 41%
  • In two cited trials of gemcitabine plus cisplatin, objective response rates were 48% and 33% in a total of 74 patients
  • The review gave operative mortality for extrapleural pneumonectomy as around 6% and described the role of radical surgery as controversial
  • In a cited prevention study, daily retinol was associated with a lower rate of mesothelioma in crocidolite-exposed individuals compared with daily betacarotene, which seemed to have no significant effect
• The authors' conclusion: The authors considered pemetrexed and cisplatin the standard of care for first-line palliative chemotherapy in patients with good performance status. They stated that gene therapy has no established place in standard mesothelioma therapy.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, SV40, Mesothelioma, Pathology, Cytopathology, Fine-Needle Aspiration, Histopathology.

Related studies

• Predicting survival in malignant mesothelioma — A.W. Musk, N. Olsen, et al. (2011)
• Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis — A. Reid, N.H. de Klerk, et al. (2014)
• Malignant pleural and peritoneal mesotheliomas in former miners and millers of crocidolite at Wittenoom, Western Australia — G. Berry, N.H. de Klerk, et al. (2004)
• Malignant mesotheliomas in former miners and millers of crocidolite at Wittenoom (Western Australia) after more than 50 years follow-up — G. Berry, A. Reid, et al. (2012)
• Mortality of former crocidolite (blue asbestos) miners and millers at Wittenoom — A.W. Musk, N.H. de Klerk, et al. (2008)
• The incidence of malignant mesothelioma in Australia, 1947-1980 — A.W. Musk, P.J. Dolin, et al. (1989)

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