Malignant Pleural Mesothelioma: A Comprehensive Review

Our plain-English summary of Malignant Pleural Mesothelioma: A Comprehensive Review, by M. Jain, M.K. Crites, P. Rich, et al (Journal of Clinical Medicine, 2024).

The study

• Authors: M. Jain, M.K. Crites, P. Rich, B. Bajantri
• Journal: Journal of Clinical Medicine
• Published: 2024;13(19)
• Type of article: Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesotheliomas are hyperplastic tumors that envelop the serosal membranes that safeguard the body's external surfaces. Although certain instances may exhibit indolent characteristics, a significant number of tumors demonstrate rapid progression and a poor prognosis. Mesotheliomas are typically categorized as benign or malignant, with malignant mesothelioma being more frequently linked to asbestos exposure. Malignant pleural mesothelioma (MPM) predominantly impacts males and often emerges in the late 50 s or beyond, characterized by a median age of early 70 s among patients exposed to asbestos lasting from 2 to 4 decades. Respiratory exposure to asbestos particles leads to the development of malignant mesothelioma, characterized by recurrent inflammation, disruption of cell division, activation of proto-oncogenes, and generation of free radicals. In pleural mesothelioma, BAP1, CDKN2A, and NF are the most often mutated genes. Accurate diagnosis and assessment usually require the use of chest computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET). Radiation therapy, immunotherapy, chemotherapy, and surgery are some of the treatment options that are currently available. This systematic review provides a comprehensive analysis of the latest research, biomarkers, evaluation, and management strategies for malignant pleural mesothelioma.

In plain English

This article was a review and reported no new data. The authors searched PubMed for English-language articles and summarized published work on malignant pleural mesothelioma (MPM), without saying how many articles they included. Citing other sources, they wrote that MPM mainly affects males, with a median age of 72 and exposure histories of 2 to 4 decades. They also wrote that symptoms may not appear until 10 to 50 years after asbestos exposure. They stated that crocidolite has been shown to be the most potent carcinogen and that BAP1, CDKN2A and NF2 are the most often mutated genes. Two of the treatment trials they discussed, both run by others, were MARS 2 and MAPS. In MARS 2, median survival was 19.3 months with extended pleurectomy decortication plus chemotherapy versus 24.8 months with chemotherapy alone. In MAPS (448 patients), median overall survival was 18.8 months (95% CI 15.9 to 22.6) with bevacizumab added to cisplatin and pemetrexed versus 16.1 months (95% CI 14.0 to 17.9) without it. The authors concluded that a multidisciplinary method addressing individual patient needs will provide a stronger outcome.

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 literature review (called a 'systematic review' in the abstract) based on a PubMed keyword search; no new data were collected
• Who was studied: Published English-language articles on mesothelioma retrieved from PubMed and selected by two of the authors by title, abstract and full text; the number of articles and the search dates are not reported
• Exposure: Asbestos in general. The article names tremolite, actinolite, anthophyllite, crocidolite and chrysotile, describes a link between amphibole exposure and MPM, and states, citing other sources, that crocidolite has been shown to be the most potent carcinogen
• Main results:
  • Citing other sources: MPM mainly affects males, with a median age of 72 and a history of asbestos exposure spanning 2 to 4 decades
  • Citing other sources: symptoms of mesothelioma may not appear until 10 to 50 years after asbestos exposure
  • Citing another source (a university news release): the five-year survival rate for mesothelioma is approximately 10%
  • Citing other sources: the genes most often mutated in MPM are BAP1, CDKN2A and NF2
  • Citing other sources: the epithelioid type is the most frequently observed and is linked to the most favorable outcome
  • Citing other sources: examining pleural fluid cells accurately diagnoses just under a third of MPM cases
  • Reporting the MARS 2 trial (another study): patients who had extended pleurectomy decortication plus chemotherapy had a median survival of 19.3 months, versus 24.8 months for those who received only chemotherapy
  • Reporting the MAPS trial (another study; 448 MPM patients randomly assigned to cisplatin and pemetrexed with or without bevacizumab): median overall survival was 18.8 months (95% CI: 15.9 to 22.6) with bevacizumab versus 16.1 months (95% CI: 14.0 to 17.9) with chemotherapy alone, p = 0.017
  • Reporting the MAPS trial: progression-free survival was 9.2 (8.5 to 10.5) months with bevacizumab plus chemotherapy versus 7.3 (6.7 to 8.0) months with standard care, p less than 0.0001
• The authors' conclusion: The authors concluded that mesothelioma, mostly associated with asbestos exposure, requires a comprehensive approach to diagnosis and treatment, and that a multidisciplinary method addressing individual patient needs will provide a stronger outcome and better quality of life

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Prognosis, Malignant Mesothelioma, Asbestos Exposure, Inflammation, BAP1, CDKN2A.

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