Malignant pleural mesothelioma: an update

Our plain-English summary of Malignant pleural mesothelioma: an update, by G.N.M. Hajj, C.H. Cavarson, C.A.L. Pinto, et al (Jornal Brasileiro de Pneumologia, 2021).

The study

• Authors: G.N.M. Hajj, C.H. Cavarson, C.A.L. Pinto, G. Venturi, J.R. Navarro, V.C.C. Lima
• Journal: Jornal Brasileiro de Pneumologia
• Published: 2021;47(6):e20210129
• Type of article: Review
• Language: Portuguese
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesotheliomas are rare types of cancers that affect the mesothelial surfaces, usually the pleura and peritoneum. They are associated with asbestos exposure, but due to a latency period of more than 30 years and difficult diagnosis, most cases are not detected until they reach advanced stages. Treatment options for this tumor type are very limited and survival ranges from 12 to 36 months. This review discusses the molecular physiopathology, current diagnosis, and latest therapeutic options for this disease.

In plain English

This article was a narrative review of published research on malignant mesothelioma, mainly malignant pleural mesothelioma. It reported no new clinical study; its scan and microscope images were illustrations. Citing other studies, the authors stated that mesothelioma is associated with occupational or environmental asbestos exposure in 80% of cases, that only 2-10% of exposed people develop it, and that latency from first exposure to diagnosis is about 30 years. They described asbestos exposure as only very weakly associated with peritoneal mesothelioma. For Brazil, they cited mesothelioma mortality rising from 0.64 deaths per million population in 1980 to 1.18 in 2002. It also covered tumor genetics, diagnosis, and treatment. It covered inherited mutations, reported in about 12% of pleural mesothelioma patients and most often in the BAP1 gene. It described one trial in which ipilimumab plus nivolumab, given first-line for unresectable pleural mesothelioma, gave longer overall survival than cisplatin or carboplatin plus pemetrexed (18.1 versus 14.1 months). The authors concluded that the disease is largely preventable, called for a ban on the asbestos industry, and said more robust research is needed.

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 published literature on malignant mesothelioma (molecular mechanisms, diagnosis, treatment)
• Who was studied: No new clinical study. The authors reviewed published studies on malignant mesothelioma, mainly pleural. As illustrations, the article includes chest scan images from one male patient with biphasic pleural mesothelioma and microscope images of mesothelioma tissue.
• Exposure: Asbestos exposure, occupational or environmental, as discussed from the literature. The review stated that the association between amphiboles and malignant pleural mesothelioma is well described and that crocidolite is considered the most oncogenic.
• Main results:
  • The review stated, citing another study, that malignant mesothelioma is associated with occupational or environmental asbestos exposure in 80% of cases.
  • The review stated that only a small proportion of asbestos-exposed individuals (2-10%) develop malignant mesothelioma, and that the reason is unknown.
  • The review stated that the latency from first asbestos exposure to diagnosis of malignant mesothelioma is about 30 years.
  • The review described asbestos exposure as only very weakly associated with peritoneal malignant mesothelioma.
  • Citing Brazilian studies, the review reported that the mesothelioma mortality rate in Brazil rose from 0.64 deaths per million population in 1980 to 1.18 deaths per million population in 2002.
  • The review stated that germline mutations in cancer predisposition genes are reported in about 12% of malignant pleural mesothelioma patients, with BAP1 the most frequently mutated gene (3-7% of cases).
  • The review described the CheckMate-743 trial, which compared ipilimumab plus nivolumab with cisplatin or carboplatin plus pemetrexed as first-line therapy for unresectable malignant pleural mesothelioma. Overall survival was longer with ipilimumab plus nivolumab (18.1 versus 14.1 months; the article gives HR 0.74, 95% CI 0.6-0.91, p=0.002).
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma is largely preventable and that global efforts should be made to ban the asbestos industry. They also concluded that the disease remains an unmet medical need and lacks robust prospective studies and randomized trials.

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, Malignant Mesothelioma, Pleura, Peritoneum, Asbestos Exposure, Latency.

Related studies

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• Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence — C. Cao, Z. Akhunji, et al. (2015)
• An update on pleuro-pulmonary cytopathology: Part i: Cytological diagnosis of mesothelioma and molecular cytology of lung cancer with an historical perspective — C.W. Bedrossian (2015)
• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
• Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group — A.N. Husain, T. Colby, et al. (2013)

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