Malignant pleural mesothelioma

Our plain-English summary of Malignant pleural mesothelioma, by D.S. Ettinger, W. Akerley, H. Borghaei, et al (Journal of the National Comprehensive Cancer Network, 2012).

The study

• Authors: D.S. Ettinger, W. Akerley, H. Borghaei, A. Chang, R.T. Cheney, L.R. Chirieac, T.A. D'Amico, T.L. Demmy, A.K. Ganti, R. Govindan, F.W. Grannis, L. Horn, T.M. Jahan, M. Jahanzeb, A. Kessinger, R. Komaki, F.M. Kong, M.G. Kris, L.M. Krug, I.T. Lennes, B.W. Loo, R. Martins, J. O'Malley, R.U. Osarogiagbon, G.A. Otterson, J.D. Patel, M.P. Schenck, K.M. Pisters, K. Reckamp, G.J. Riely, E. Rohren, S.J. Swanson, D.E. Wood, S.C. Yang, National Comprehensive Cancer Network
• Journal: Journal of the National Comprehensive Cancer Network
• Published: 2012;10(1):26-41
• Type of article: Guideline
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This article presented the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for malignant pleural mesothelioma (MPM). The guidelines were developed by the NCCN Non–Small Cell Lung Cancer panel in 2010 and were described as a consensus statement of the authors' views of currently accepted treatment approaches. The authors noted that mesothelioma occurs in approximately 2500 people in the United States each year, mainly in older men exposed to asbestos 20 to 40 years earlier, and that median overall survival is approximately 1 year. Screening for MPM was not recommended. For recurrent pleural effusion or pleural thickening, the recommended initial evaluation included chest CT with contrast, thoracentesis for cytology, and pleural biopsy, with thoracoscopic biopsy preferred. Management by an experienced multidisciplinary team was recommended. For medically operable patients with clinical stage I to III disease, trimodality therapy was recommended: chemotherapy, surgery by pleurectomy/decortication or extrapleural pneumonectomy, and radiotherapy. Chemotherapy alone was recommended for inoperable patients and for those with stage IV disease or sarcomatoid histology. Cisplatin plus pemetrexed (category 1) was described as the gold-standard first-line regimen; in a phase III trial it increased survival compared with cisplatin alone (12.1 vs. 9.3 months). Radiotherapy alone was not recommended. Radiotherapy could be used after extrapleural pneumonectomy, to prevent instrument-tract recurrence, and to relieve chest pain.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article is not a research study. It is a clinical practice guideline: a consensus statement by a National Comprehensive Cancer Network (NCCN) panel on diagnosing and treating malignant pleural mesothelioma (MPM), drawing on studies by other researchers. As background, it noted that MPM occurs mainly in older men who have been exposed to asbestos. The guideline did not recommend screening for MPM. For suspected MPM, it recommended a chest CT with contrast, thoracentesis (draining chest fluid) for cytology, and a pleural biopsy, with thoracoscopic biopsy preferred. It recommended trimodality therapy (chemotherapy, surgery and radiotherapy) for medically operable patients with clinical stage I to III disease. It recommended chemotherapy alone for inoperable patients, stage IV disease or sarcomatoid histology. Cisplatin with pemetrexed was the category 1 first-line regimen. A cited trial reported survival of 12.1 months with that combination versus 9.3 months with cisplatin alone. Radiotherapy alone was not recommended. The authors stated that the choice of surgery is controversial because randomized trial data are not available. NCCN stated that the best management for any cancer patient is in a clinical trial.

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: Clinical practice guideline (expert panel consensus statement, Version 2.2012) summarizing other studies; not original research
• Who was studied: Patients with suspected or confirmed malignant pleural mesothelioma; guideline developed by the NCCN Non–Small Cell Lung Cancer panel in 2010
• Exposure: Not an exposure study. As background citing other work, the guideline stated that MPM occurs mainly in older men (median age 72) exposed to asbestos, decades after exposure. It also mentioned reports linking radiotherapy and erionite to the disease.
• Main results:
  • The guideline did not recommend screening for MPM, including in people with asbestos exposure.
  • Recommended initial evaluation for suspected MPM included chest CT with contrast, thoracentesis for cytology, and pleural biopsy, with thoracoscopic biopsy preferred.
  • Trimodality therapy (chemotherapy, surgery, radiotherapy) was recommended for medically operable patients with clinical stage I to III MPM.
  • Chemotherapy alone was recommended for inoperable patients, clinical stage IV MPM, or sarcomatoid histology.
  • Cisplatin plus pemetrexed (category 1) was named the first-line standard. A cited phase III trial (not this article's own data) reported survival of 12.1 months with the combination versus 9.3 months with cisplatin alone, P = .02.
  • Extrapleural pneumonectomy may be the best option for good-risk patients with early disease and epithelioid histology.
  • Radiotherapy alone was not recommended. Adjuvant radiation after extrapleural pneumonectomy should be 50 to 60 Gy in 1.8 to 2.0 Gy fractions.
• The authors' conclusion: The authors recommended management by an experienced multidisciplinary team and stated that the best management for any cancer patient is in a clinical trial.
• Limitations the authors state:
  • The choice of surgery is controversial because randomized controlled trial data are not available.
  • Limited data are available to guide second-line chemotherapy.
  • The optimal radiation dose for palliative purposes remains unclear.
  • Accurate staging before surgery is difficult.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Small Cell Lung Cancer, Mesothelioma, Median Overall Survival, Pleural Effusion, Pleural Thickening, Thoracentesis, Cytology.

Related studies

• NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016 — D.S. Ettinger, D.E. Wood, et al. (2016)
• Scientific Advances in Thoracic Oncology 2016 — R.A. Soo, E.C.A. Stone, et al. (2017)
• Comprehensive genomic analysis of malignant pleural mesothelioma identifies recurrent mutations, gene fusions and splicing alterations — R. Bueno, E.W. Stawiski, et al. (2016)
• Lung cancer in never smokers: a review — J. Subramanian, R. Govindan (2007)
• Integrative Molecular Characterization of Malignant Pleural Mesothelioma — J. Hmeljak, F. Sanchez-Vega, et al. (2018)
• COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study — M.C. Garassino, J.G. Whisenant, et al. (2020)

Browse more research in Journal of the National Comprehensive Cancer Network, or return to medical research.