Malignant mesothelioma 2008

Our plain-English summary of Malignant mesothelioma 2008, by M.D. Zervos, C. Bizekis, H.I. Pass (Current Opinion in Pulmonary Medicine, 2008).

The study

• Authors: M.D. Zervos, C. Bizekis, H.I. Pass
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2008;14(4):303-9
• Type of article: Review
• Cited by: 41 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose Of Review: Mesothelioma is an aggressive malignancy of the pleura with poor survival. There will be approximately 3000 cases of mesothelioma in the United States annually. Multimodality treatment including neoadjuvant chemotherapy in selected individuals followed by extrapleural pneumonectomy and radiation has been studied in recent trials for its effects on disease free and overall survival This review provides a general overview of malignant mesothelioma with a summary of the most significant articles from within the past year as well as from the past.

Recent Findings: Areas of recent interest include the evaluation of osteopontin and mesothelin as new tumor markers for mesothelioma. New phase III trials have been performed to evaluate the use of combined chemotherapy regimens.

Summary: Malignant mesothelioma is a very difficult malignancy to treat. Patients with the disease usually have an occupational asbestos exposure, and in some, viral exposure with SV40. There have been many historical treatments including combinations of local control with surgery and radiation as well as attempts to prevent systemic failure with chemotherapy. Novel therapies including intrapleural chemotherapy, photodynamic therapy and hyperthermic perfusion have also been used with some success. Finally there are several attempts at immunomodulating and targeted treatments, which are in phase I/II trials.

In plain English

This article was a review, not a new study. The authors gave a general overview of malignant mesothelioma, summarizing articles from the past year and earlier. They stated that patients usually have occupational asbestos exposure and, in some, exposure to the virus SV40. The findings described came from other studies, some by coauthor Harvey I. Pass, plus preliminary trial results presented at the ASCO 2007 conference. A cited study of 48 patients found that mesothelin (SMRP), a blood marker, had 83% sensitivity and 95% specificity. Another cited study found that osteopontin separated asbestos-exposed people with mesothelioma from those without cancer. On drug treatment, it cited a phase III trial in which pemetrexed with cisplatin gave a median survival of 12 months, versus 9.3 months with cisplatin alone. It also summarized surgery, radiation and combined treatments. For example, a Swiss trial of three cycles of cisplatin and gemcitabine before extrapleural pneumonectomy, with radiation therapy considered, reported a median survival of 23 months. The authors concluded that multimodality therapy appears to be the most acceptable current approach. They added that it remains very difficult to treat, with poor survival overall.

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 literature on malignant mesothelioma (no new data collected by the authors)
• Who was studied: No study population of its own; the review covered articles on malignant mesothelioma from the past year and earlier
• Exposure: The review stated that patients usually have occupational asbestos exposure and, in some, viral exposure with SV40. No fiber types were specified in the review's own text.
• Main results:
  • Cited study (Beyer et al.): in 48 patients, serum mesothelin (SMRP) was a biomarker with 83% sensitivity and 95% specificity
  • Cited study by Pass et al. (an author group that includes the review's coauthor Harvey I. Pass): SMRP was a promising marker for malignant pleural mesothelioma in blood and pleural fluid
  • Cited study: osteopontin (OPN) levels could be used to separate asbestos-exposed patients with mesothelioma from asbestos-exposed patients without malignancy
  • Cited phase III trial: median survival was 12 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone
  • Cited phase III trial of raltitrexed plus cisplatin versus cisplatin alone: median survival 11.4 versus 8.8 months
  • Cited Swiss trial: patients given three cycles of cisplatin and gemcitabine followed by extrapleural pneumonectomy, with radiation therapy considered, had a median survival of 23 months
  • Preliminary results of a North American trial presented at ASCO 2007, using cisplatin and pemetrexed followed by extrapleural pneumonectomy and hemithoracic radiotherapy: median survival of 16 months
  • Cited study (Schipper et al.): overall mortality after extrapleural pneumonectomy was 6.3%
  • Cited trials (Pass et al.): surgery with intraoperative photodynamic therapy versus surgery without it showed no difference in survival, 14.4 versus 14.1 months
  • The success rate of talc pleurodesis for managing pleural effusion was estimated at approximately 90%
• The authors' conclusion: The authors concluded that mesothelioma remains very difficult to treat with poor survival overall, and that multimodality therapy appears to be the most acceptable current approach for treatment

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Pleura, Neoadjuvant Chemotherapy, Extrapleural Pneumonectomy (EPP), Overall Survival, Osteopontin, Mesothelin.

Related studies

• Current concepts in malignant pleural mesothelioma — A.J. Kaufman, H.I. Pass (2008)
• Future developments in the management of malignant pleural mesothelioma — P.A. Zucali, F. De Vincenzo, et al. (2009)
• Malignant pleural mesothelioma — H.L. Kindler (2000)
• Malignant pleural mesothelioma — S.E. Chen, M.B. Pace (2012)
• Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting — R.R. Gill, A.S. Tsao, et al. (2019)
• Preoperative assessment and therapeutic options for patients with malignant pleural mesothelioma — S. Paul, S. Neragi-Miandoab, et al. (2004)

Browse more research in Current Opinion in Pulmonary Medicine, or return to medical research.