Malignant mesothelioma without asbestos exposure diagnosed during EGFR-TKI treatment of lung adenocarcinoma: A case report

Our plain-English summary of Malignant mesothelioma without asbestos exposure diagnosed during EGFR-TKI treatment of lung adenocarcinoma: A case report, by X. Niu, C. Zhou, A. Hu, et al (Cancer Treatment and Research Communications, 2021).

The study

• Authors: X. Niu, C. Zhou, A. Hu, L. Su, D. Lin, H. Han, Y. Lu
• Journal: Cancer Treatment and Research Communications
• Published: 2021;27:100345
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Synchronous malignant mesothelioma (MM) and lung carcinoma are extremely rare in patients without a history of asbestos exposure and poses tremendous difficulties in clinical management. We report a patient without asbestos exposure diagnosed with MM during EGFR-TKI treatment of lung adenocarcinoma (LUAD), who responded to first-line chemotherapy with pemetrexed plus carboplatin and failed to subsequent systemic therapy. Clinicians should be careful about the possibility of MM comorbidity in LUAD patients whose lesions respond differently to EGFR-TKI, even in those without a history of asbestos exposure.

Copyright © 2021. Published by Elsevier Ltd.

In plain English

This was a case report of one patient, a 59-year-old male smoker (35 pack-years), described by authors at hospitals in Shanghai, China. The authors reported that he had no asbestos exposure. The article does not describe how his exposure history was taken. In July 2018 a spine biopsy showed lung adenocarcinoma, and blood testing found an EGFR mutation. He was treated with targeted drugs (EGFR-TKIs) and chemotherapy, and his cancer responded at first and then progressed. Later, on the drug erlotinib, his brain lesions went into remission and his chest lesions stayed stable, while his liver lesions grew. A liver biopsy then showed epithelioid malignant mesothelioma rather than lung cancer. No pleural biopsy was done. The authors suggested the pleura as the most likely origin and did not consider peritoneal mesothelioma, because abdominal CT showed nothing abnormal apart from the liver lesions. Further treatments did not control the liver disease, and he died 3 months after erlotinib plus anlotinib was started in February 2020. The authors concluded that clinicians should be alert to possible mesothelioma in lung adenocarcinoma patients, even those without asbestos exposure.

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: case report (single patient)
• Who was studied: One 59-year-old male smoker (35 pack-years) with stage IV lung adenocarcinoma, first biopsied in July 2018. The authors are based at hospitals in Shanghai, China.
• Exposure: No asbestos exposure was reported for this patient. He was a smoker. The article does not describe how asbestos exposure history was assessed.
• Main results:
  • The patient's lung adenocarcinoma showed a partial response 28 days after first-line gefitinib was started. The disease progressed after 10 months, with liver and brain metastases.
  • A partial response was achieved with first-line chemotherapy (pemetrexed plus carboplatin, 6 cycles, June to September 2019).
  • On erlotinib, the brain lesions went into remission and the chest lesions stayed stable, but the liver lesions progressed.
  • A liver biopsy showed epithelioid malignant mesothelioma. It was negative for TTF-1, which had been positive in the earlier spine biopsy. The authors said this strongly suggested a second cancer rather than lung adenocarcinoma.
  • No pleural biopsy was performed. The authors suggested the pleura as the most likely origin of the mesothelioma.
  • Despite further treatment, the liver lesions kept progressing. The patient died 3 months after erlotinib plus anlotinib was started in February 2020.
• The authors' conclusion: The authors concluded that clinicians should be careful about the possibility of mesothelioma alongside lung adenocarcinoma, even in patients without asbestos exposure, particularly when lesions respond differently to treatment.

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, Asbestos Exposure, EGFR, Lung Adenocarcinoma, Carcinoma, Chemotherapy, Pemetrexed (Alimta), Carboplatin.

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