Malignant pleural mesothelioma--an update

Our plain-English summary of Malignant pleural mesothelioma--an update, by D.J. Stewart, J.G. Edwards, W.R. Smythe, et al (International Journal of Occupational and Environmental Health, 2004).

The study

• Authors: D.J. Stewart, J.G. Edwards, W.R. Smythe, D.A. Waller, K.J. O'Byrne
• Journal: International Journal of Occupational and Environmental Health
• Published: 2004;10(1):26-39
• Type of article: Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Exposure to asbestos is the most frequent, but not exclusive, cause of malignant mesothelioma. Clinical features include dyspnea, cough, nonspecific chest pain, weight loss and night sweats. Diagnosis may be complicated by histologic difficulties. Thoracoscopic techniques are proving beneficial, but no one method of imaging has proven superior, and disease staging is inconsistent. Conventional treatments such as chemotherapy, surgery, and radiotherapy have had variable impacts, although chemotherapy is useful in palliation and can improve both survival and quality of life. There is hope for new antimetabolite agents. The role of radical surgery is yet to be evaluated in a large trial. New radiotherapeutic techniques to improve local control are promising. Multimodality treatments appear to be the most successful for management of potentially resectable disease. It is likely that biological markers will improve accuracy in staging and prognosis. With new treatments based on better understanding of the biology of the disease, there is cautious optimism for the future for patients with malignant pleural mesothelioma.

In plain English

This article was a narrative review of published research on malignant pleural mesothelioma. It reported no new patient data of its own. It covered causes, symptoms, prognosis, diagnosis, staging, chemotherapy, surgery, radiotherapy, combined treatments and experimental therapies. The review stated that around 80% of people who develop mesothelioma have occupational or environmental asbestos exposure above background levels. It also stated that most reported patient series gave median survivals of four to 18 months. Among the other studies it described, a preliminary phase III trial reported a median survival of 12.1 months with pemetrexed plus cisplatin, compared with 9.3 months with cisplatin alone. A series of 183 patients treated with extrapleural pneumonectomy followed by chemotherapy and radiotherapy reported survival of 38% at two years and 15% at five years among the remaining 176 patients. The authors concluded that mesothelioma was at present incurable and that only chemotherapy had proven able to provide effective palliation. They also concluded that treatment combining several methods was most likely to lead forward, and that there was reason for very cautious optimism.

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 (update) of published literature on malignant pleural mesothelioma; no new data collected
• Who was studied: No study population of its own; the review summarized published studies of patients with malignant pleural mesothelioma, plus laboratory and animal studies of experimental treatments
• Exposure: Asbestos exposure was discussed as the most frequent but not the only cause, with no specific fiber types named. Other candidate factors listed were Simian virus 40, radiation, other minerals such as erionite, and previous pleural scarring.
• Main results:
  • The review stated that around 80% of people who develop mesothelioma have occupational or environmental exposures to asbestos above background levels, and that approximately only 5% of people exposed develop the disease.
  • The review reported that most published patient series gave median survivals of four to 18 months.
  • Describing preliminary results of a large phase III trial presented in 2002, the review reported:
• Overall response rate: 41% in the pemetrexed and cisplatin arm, 17% for cisplatin alone.
• Median survival: 12.1 months versus 9.3 months, respectively.
  • Describing a published trimodality series by Sugarbaker et al., the review reported:
• 183 patients underwent extrapleural pneumonectomy followed by chemotherapy and radiotherapy.
• Perioperative mortality was 3.8% (7 patients).
• Among the remaining 176 patients, survival was 38% at two years and 15% at five years (median 19 months).
  • In the same series, the subset of 31 patients without the three poor prognostic factors had survival of 68% at two years and 46% at five years, with a median survival of 51 months. The three factors were mixed or sarcomatoid cell type, tumor-containing extrapleural lymph nodes, and positive resection margins.
  • The review reported that operative mortality for extrapleural pneumonectomy was 31% in one early series and had since been reduced to approximately 5%.
• The authors' conclusion: The authors concluded that mesothelioma is at present incurable, with only chemotherapy having proven capable of providing effective palliation. They judged that multimodality therapy is most likely to lead forward, and that therapeutic nihilism should be replaced with very cautious optimism.
• Limitations the authors state:
  • The authors noted that because mesothelioma is relatively rare, many chemotherapy studies enrolled only small numbers of patients. They added that differing staging systems and outcome measures made comparisons between studies 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, Mesothelioma, Dyspnea, Staging, Chemotherapy, Quality of Life, Prognosis.

Related studies

• Malignant pleural mesothelioma: update on treatment options with a focus on novel therapies — A.R. Haas, D.H. Sterman (2013)
• Mesothelioma: new concepts in diagnosis and management — A.M. Boylan (2000)
• Updates in the diagnosis and treatment of malignant pleural mesothelioma — D. Katzman, D.H. Sterman (2018)
• Mesothelioma from chrysotile asbestos: update — M.S. Kanarek (2011)
• The role of imaging in malignant pleural mesothelioma: an update after the 2018 BTS guidelines — S. Sinha, A.J. Swift, et al. (2020)
• Malignant pleural mesothelioma: an update on biomarkers and treatment — M. Ray, H.L. Kindler (2009)

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