Malignant pleural mesothelioma: an update on diagnosis and treatment options

Our plain-English summary of Malignant pleural mesothelioma: an update on diagnosis and treatment options, by S. Kondola, D. Manners, A.K. Nowak (Therapeutic Advances in Respiratory Disease, 2016).

The study

• Authors: S. Kondola, D. Manners, A.K. Nowak
• Journal: Therapeutic Advances in Respiratory Disease
• Published: 2016;10(3):275-88
• Type of article: Review
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) represents a significant diagnostic and therapeutic challenge and is almost always a fatal disease. Imaging abnormalities are common, but have a limited role in distinguishing mesothelioma from metastatic pleural disease. Similarly, minimally invasive biomarkers have shown promise but also have limitations in the diagnosis of mesothelioma. In experienced centers, cytology and immunohistochemistry are now sufficient to diagnose the epithelioid subtype of mesothelioma, which can reduce the need for more invasive diagnostic investigations. Prognosis of MPM is modestly impacted by oncological treatments. Chemotherapy with cisplatin and pemetrexed is considered the standard of care, though the addition of bevacizumab to the platinum doublet may be the new standard of care. New targeted therapies have demonstrated some promise and are being addressed in clinical trials. This review focuses on the current data on the diagnostic and therapeutic issues of MPM.

© The Author(s), 2016.

In plain English

This article is a review, not a new study. The authors summarized published research and ongoing clinical trials on diagnosing and treating malignant pleural mesothelioma. Citing earlier work, they noted that mesothelioma is almost exclusively due to asbestos exposure. Among the studies it described, a 2003 trial (EMPHACIS) found that cisplatin plus pemetrexed improved median survival from 9.3 to 12.1 months compared with cisplatin alone. The MAPS trial of 448 patients reported median overall survival of 18.8 months when bevacizumab was added, against 16.1 months without it. On diagnosis, a cited study found soluble mesothelin worked better than fibulin-3 as a blood marker. The review also said that, in experienced hands, the epithelioid subtype can be diagnosed from pleural fluid cytology with immunohistochemical staining, while sarcomatoid effusions often contain too few cells for cytology. A small pilot trial of radical surgery (MARS) reported shorter median survival in the surgery group, though the authors said its results should be viewed with caution. The authors concluded that treatment modestly affects prognosis and that the best role of surgery remains unclear.

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 studies and ongoing clinical trials on diagnosis and treatment of malignant pleural mesothelioma
• Who was studied: No study population of its own. The review covers published research and clinical trials in patients with malignant pleural mesothelioma (MPM).
• Exposure: Not an exposure study. Citing earlier work, the introduction states that mesothelioma is almost exclusively due to asbestos exposure.
• Main results:
  • Reported from the cited EMPHACIS trial (Vogelzang et al. 2003): in patients with MPM, cisplatin plus pemetrexed compared with cisplatin alone improved median survival from 9.3 to 12.1 months (HR 0.74, p = 0.003)
  • Reported from the cited MAPS trial (Zalcman et al. 2015) of 448 patients with advanced mesothelioma: median overall survival was 18.8 months in the bevacizumab plus cisplatin/pemetrexed arm versus 16.1 months with cisplatin/pemetrexed alone (HR 0.76, p = 0.012)
  • Reported from a cited study (Creaney et al. 2014): the AUC was 0.822 for mesothelin compared with 0.671 for fibulin-3. The review takes this to suggest soluble mesothelin remains the most useful diagnostic biomarker.
  • Citing Segal et al. 2013 and International Mesothelioma Interest Group recommendations, the review states that in experienced hands MPM can be diagnosed on pleural fluid cytology combined with immunohistochemistry, and that cytological diagnosis of epithelioid mesothelioma is possible
  • The review states that effusions in sarcomatoid MPM are often paucicellular (contain few cells), which limits the role of cytology
  • Reported from the cited pilot MARS trial (24 patients randomized to extrapleural pneumonectomy, 26 to no extrapleural pneumonectomy): median survival was 14.4 months in the surgery group and 19.5 months in the no-surgery group. The authors note the trial has been criticized and its results should be regarded with caution.
  • Reported from the cited KEYNOTE-028 trial (25 enrolled patients with pretreated mesothelioma given pembrolizumab): early results showed partial response in 28% and stable disease in 48% of participants
• The authors' conclusion: The authors concluded that prognosis can be modestly affected by chemotherapy and VEGF-targeting treatment, and that the optimal role of surgery remains unclear and controversial.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Biomarker, Cytology, Immunohistochemistry, Epithelioid, Prognosis, Chemotherapy.

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