Malignant Mesothelioma: Has Anything Changed?

Our plain-English summary of Malignant Mesothelioma: Has Anything Changed?, by R.Y. Kim, D.H. Sterman, A.R. Haas (Seminars in Respiratory and Critical Care Medicine, 2019).

The study

• Authors: R.Y. Kim, D.H. Sterman, A.R. Haas
• Journal: Seminars in Respiratory and Critical Care Medicine
• Published: 2019;40(3):347-360
• Type of article: Review
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is a rare cancer associated with asbestos exposure and portends a dismal prognosis. Its worldwide incidence has been increasing, and treatment options are currently suboptimal and noncurative. However, since the turn of the century, several encouraging steps have been made toward improving outcomes for mesothelioma patients. An increased understanding of disease pathophysiology has led to more accurate diagnosis and staging, and the establishment of the standard of care first-line pemetrexed/platin doublet chemotherapy regimen in 2003 initially revolutionized treatment. While significant debate remains regarding the preferred approach to surgical and radiation therapy in the context of multimodal therapy, recent breakthroughs in immunotherapy offer hope for another paradigm shift in the near future. This review will summarize the current clinical approach to diagnosis, staging, and treatment of malignant pleural mesothelioma.

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In plain English

This article was a narrative review, not a new study. The authors summarized published research on diagnosing, staging and treating malignant pleural mesothelioma. They described the disease as having a well-established causal link with exposure to mineral fibers such as asbestos and erionite. The article did not describe how the studies it discussed were chosen. Drawing on other studies, the authors wrote that pleural fluid cytology diagnosed under 33% of cases. They wrote that epithelial mesothelioma had the most favorable survival (12 to 27 months) and sarcomatoid the worst (4 to 18 months). They reported that a 2003 trial found median survival of 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone. They also described changes to the staging system in its eighth edition, conflicting evidence on surgery, and a 2017 trial in which tremelimumab did not significantly improve survival compared with placebo. The authors concluded that outcomes had progressively improved over the past decade. They also concluded that immunotherapy will likely soon be regarded as a fourth pillar of treatment, alongside chemotherapy, surgery and radiation.

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 pleural mesothelioma; no method for selecting studies is described
• Who was studied: No study population of its own; the review covers published studies of patients with malignant pleural mesothelioma
• Exposure: Exposure was not studied. In background, the authors describe a well-established causal relationship between mineral fibers such as asbestos and erionite and malignant pleural mesothelioma. The review itself concerns diagnosis, staging and treatment.
• Main results:
  • Citing other studies, the authors reported that pleural fluid cytology has an overall diagnostic yield for malignant pleural mesothelioma of under 33%.
  • Citing other studies, the authors reported survival by tissue type: epithelial mesothelioma (about 60% of cases) has the most favorable prognosis, with overall survival of 12 to 27 months.
  • Citing other studies, the authors reported that sarcomatoid mesothelioma (about 20% of cases) has the worst prognosis, with overall survival of 4 to 18 months.
  • Citing other studies, the authors reported that soluble mesothelin-related protein (SMRP), a blood marker, had a sensitivity of only 32% (95% CI: 26 to 40%) at 95% specificity in a study of 217 patients with stage I or II mesothelioma and 1,612 controls.
  • Citing a 2003 phase 3 trial of over 400 patients (Vogelzang et al.), the authors reported median overall survival of 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone.
  • Citing the MAPS phase 3 trial of 448 patients, the authors reported that adding bevacizumab to pemetrexed and cisplatin improved median overall survival (18.8 vs. 16.1 months), with a hazard ratio of 0.77 (95% CI: 0.62 to 0.95).
  • Citing a 2018 meta-analysis (van Gerwen et al.), the authors reported significantly higher 30-day mortality after extrapleural pneumonectomy than after pleurectomy/decortication: 5% (95% CI: 4 to 6) vs. 2% (95% CI: 1 to 3).
  • Citing the DETERMINE trial (569 patients), the authors reported no significant difference in median overall survival between tremelimumab (7.7 months) and placebo (7.3 months).
  • The authors described how the eighth edition of the staging system combined the former T1a and T1b categories into a single T1 category, and the former N1 and N2 categories into a single N1 category.
• The authors' conclusion: The authors concluded that, despite a still poor overall prognosis, outcomes for malignant pleural mesothelioma have progressively improved over the past decade. They also concluded that immunotherapy will likely soon be regarded as the fourth pillar of treatment, alongside chemotherapy, surgery and radiation therapy.

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: Malignant Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, Prognosis, Mesothelioma, Staging, Pemetrexed (Alimta), Chemotherapy.

Related studies

• Multimodality treatment of malignant pleural mesothelioma with or without immunotherapy: does it change anything? — M. Lucchi, A. Picchi, et al. (2010)
• Medical treatment of mesothelioma: anything new? — N. Takigawa, K. Kiura, et al. (2011)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Soluble mesothelin, megakaryocyte potentiating factor, and osteopontin as markers of patient response and outcome in mesothelioma — K. Hollevoet, K. Nackaerts, et al. (2011)
• PI3K/mTOR signaling in mesothelioma patients treated with induction chemotherapy followed by extrapleural pneumonectomy — B.K. Bitanihirwe, M. Meerang, et al. (2014)
• 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)

Browse more research in Seminars in Respiratory and Critical Care Medicine, or return to medical research.