Malignant pleural mesothelioma: a new standard of care

Our plain-English summary of Malignant pleural mesothelioma: a new standard of care, by R.A. Stahel (Lung Cancer, 2006).

The study

• Author: R.A. Stahel
• Journal: Lung Cancer
• Published: 2006;54 Suppl 2:S9-S14
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is an asbestos-associated cancer that occurs most commonly in the pleural cavities and generally has a poor prognosis. A rise in the incidence of this fatal disease, which, in the past has been considered to be relatively refractory to therapy, is predicted over the next decade. The realisation that patients can benefit from systemic chemotherapy and more aggressive multimodal approaches, including extrapleural pneumonectomy (EPP), in earlier stages of disease now provides the opportunity to offer more effective treatment for this disease.

In plain English

This article was a narrative review by a single author at University Hospital, Zurich, about malignant pleural mesothelioma, which it called an asbestos-associated cancer. It mainly summarised other researchers' work, and also mentioned unpublished PET/CT scan observations of ongoing treatment responses beyond six cycles in several patients. Topics included projected mesothelioma deaths in Western Europe, genetic changes found in mesothelioma, chemotherapy, extrapleural pneumonectomy combined with other therapy, and targeted drugs. In a Phase III trial by Vogelzang et al., response rates were 41% with pemetrexed plus cisplatin and 17% with cisplatin alone. An update reported that 32% of combination patients and 23% of cisplatin-alone patients were alive after 18 months. A surgical study by Sugarbaker et al. reported a median survival of 19 months in 176 patients alive after surgery. The author concluded that pemetrexed plus cisplatin is now the standard first-line therapy, and that the clinical benefit of targeted agents for these patients remains to be proven. The author disclosed receiving honoraria from Eli Lilly and Company.

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 research on malignant pleural mesothelioma (epidemiology, molecular changes, chemotherapy, surgery-based multimodal therapy, targeted therapy). It also mentions some unpublished PET/CT observations whose source is not identified.
• Who was studied: No defined study population of its own. The review discussed published studies of patients with malignant pleural mesothelioma and projections of mesothelioma deaths in Western Europe. It also mentions unpublished PET/CT observations in an unspecified number of patients treated with pemetrexed plus cisplatin or pemetrexed plus carboplatin.
• Exposure: Asbestos exposure in general, discussed as the background cause of mesothelioma. No specific fiber types were analysed. The main subject was treatment: chemotherapy drugs, extrapleural pneumonectomy, radiotherapy and targeted agents.
• Main results:
  • Citing earlier projections (Peto et al.), the review reported that mesothelioma deaths among men in Western Europe over 1995 to 2029 were projected to total approximately a quarter of a million over 35 years. It added that more recent estimates suggest the peak may be earlier and lower.
  • Citing another study, the review stated that 80% of malignant pleural mesothelioma in the Western World develops in people with higher than background asbestos exposure. It also stated that fewer than 10% of heavily exposed people develop malignant mesothelioma.
  • In the Phase III trial by Vogelzang et al. described in the review, response rates were 41% for pemetrexed plus cisplatin versus 17% for cisplatin alone.
  • In updated survival data from that trial, 32% of patients on the combination treatment were alive after 18 months, compared with 23% on cisplatin alone.
  • In an EORTC Phase III study of 250 patients described in the review, median survival was 11.4 months with raltitrexed plus cisplatin versus 8.8 months with cisplatin alone. No significant difference in health-related quality of life was observed between the groups.
  • In the Sugarbaker et al. study of 183 patients given trimodality therapy including extrapleural pneumonectomy, median survival in the 176 patients alive after surgery was 19 months. Estimated 2- and 5-year survival rates were 38% and 15%.
  • In a thalidomide study of 40 patients described in the review, no responses were observed. Disease stabilisation of 6 months or more was documented in 27% of patients.
  • Unpublished serial PET/CT observations, whose source is not identified, showed ongoing responses beyond six cycles of treatment in several patients treated with pemetrexed plus cisplatin or pemetrexed plus carboplatin.
• The authors' conclusion: The author concluded that pemetrexed plus cisplatin is now the standard first-line therapy for malignant pleural mesothelioma, offering improved survival compared with cisplatin alone and potential for improved symptom control. The author also concluded that the clinical benefit of targeted agents for these patients remains to be proven.

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, Prognosis, Chemotherapy, Extrapleural Pneumonectomy (EPP).

Related studies

• Patterns of care and survival of older patients with malignant pleural mesothelioma — A. Linton, P. Blinman, et al. (2019)
• Extrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma? — S. Sharif, I. Zahid, et al. (2011)
• Extrapleural pneumonectomy after induction chemotherapy: perioperative outcome in 251 mesothelioma patients from three high-volume institutions — O. Lauk, M.A. Hoda, et al. (2014)
• Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma — T. Tokunaga, M. Higashiyama, et al. (2011)
• Pemetrexed for malignant pleural mesothelioma: Is it a standard second-line therapy? — K. Tamura, Y. Fujiwara (2010)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)

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