Malignant pleural mesothelioma

Our plain-English summary of Malignant pleural mesothelioma, by S.E. Chen, M.B. Pace (American Journal of Health-system Pharmacy, 2012).

The study

• Authors: S.E. Chen, M.B. Pace
• Journal: American Journal of Health-system Pharmacy
• Published: 2012;69(5):377-85
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Unlabelled: PURPOSE The etiology, diagnosis, staging, and management of malignant pleural mesothelioma (MPM) are reviewed, with an emphasis on clinical trials of newer approaches to first-line, second-line, and adjuvant chemotherapy.

Summary: In the past decade, more effective chemotherapy regimens have been developed for patients with MPM, a rapidly progressing disease linked to a history of asbestos exposure in about 70% of cases. Patients with MPM often require multimodal treatment with surgery, radiotherapy, and adjuvant or neoadjuvant (presurgical) chemotherapy. The current standard of first-line chemotherapy for MPM is cisplatin or carboplatin in combination with pemetrexed, an antifolate compound that has been shown to increase the cytotoxic effects of platinum-based drugs. In Phase II and III clinical trials, combination therapy with pemetrexed and either cisplatin or carboplatin yielded some of the highest rates of tumor response (21-41%) and overall survival (about 12-14 months) reported to date. Dual-agent neoadjuvant chemotherapy (cisplatin plus gemcitabine or pemetrexed) followed by radical surgery with or without radiotherapy has been reported to yield median survival of up to 23-29 months in small clinical trials, but larger randomized controlled studies are needed to better define the role of neoadjuvant therapy in MPM management. Other chemotherapeutic agents that have been used against MPM, with variable results, include gemcitabine, vinorelbine, taxanes, anthracyclines, and molecular-targeted agents.

Conclusion: Treatment approaches for MPM include surgery, radiation, and systemic chemotherapy. MPM carries a poor prognosis, but recent studies of pemetrexed and platinum analogue combination therapies have demonstrated improved response rates over other treatments.

In plain English

This article was a clinical review by two pharmacists at the University of Texas MD Anderson Cancer Center, not a new study. It covered the causes, diagnosis, staging and treatment of malignant pleural mesothelioma, emphasizing chemotherapy trials. The authors searched PubMed for English-language publications. Citing other sources, it stated that about 70% of cases are associated with asbestos exposure, usually after a latency of up to 40 years. In one cited Phase III trial of 456 patients, pemetrexed plus cisplatin gave a higher response rate than cisplatin alone (41% versus 16.7%) and longer median overall survival (12.1 versus 9.3 months). In a second-line trial, pemetrexed did not significantly improve survival over supportive care alone. In a Phase II erlotinib trial, none of the 29 patients assessed (of 63 enrolled) had an objective response. In another Phase II trial, adding bevacizumab to gemcitabine and cisplatin did not improve response rate, progression-free survival or overall survival. The authors noted that trials defined response differently. They concluded the disease carries a poor prognosis but that pemetrexed and platinum combinations have shown improved response rates.

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 clinical review of published studies and review articles, identified through a PubMed search
• Who was studied: No study population of its own; the review covered published research on malignant pleural mesothelioma (MPM)
• Exposure: Not an exposure study. Citing other sources, the review described asbestos as linked to about 70% of cases and named no fiber types. Its focus was treatment: surgery, radiotherapy and chemotherapy.
• Main results:
  • Citing other sources, the review stated that in most patients the disease develops after a latency of up to 40 years from initial exposure to carcinogens
  • In a cited Phase III trial of 456 MPM patients, pemetrexed plus cisplatin gave a higher response rate than cisplatin alone (41% versus 16.7%, p < 0.001) and longer median overall survival (12.1 versus 9.3 months, p = 0.012)
  • In a cited Phase III second-line trial of 243 previously treated patients, overall survival did not differ significantly with pemetrexed plus best supportive care versus best supportive care alone (8.4 versus 9.7 months, p = 0.74)
  • In a cited Phase II trial of erlotinib, 63 patients were enrolled and only 29 were assessed for outcomes; no objective responses were reported
  • In a cited Phase II trial, adding bevacizumab to gemcitabine and cisplatin did not improve response rate, progression-free survival or overall survival
• The authors' conclusion: The authors concluded that MPM carries a poor prognosis, but that recent studies of pemetrexed and platinum analogue combinations have shown improved response rates over other treatments. They described a platinum agent plus pemetrexed as the standard first-line treatment.
• Limitations the authors state:
  • The authors noted that the trials they cited used varying definitions of response categories

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, Etiology, Staging, Clinical Trial, Chemotherapy, Asbestos Exposure, Cisplatin, Carboplatin.

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• Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Tokunaga, M. Higashiyama, et al. (2011)
• Combined chemotherapy with cytotoxic and targeted compounds for the management of human malignant pleural mesothelioma — R.E. Favoni, T. Florio (2011)

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