Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

Our plain-English summary of Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment, by A.C. Bibby, S. Tsim, N. Kanellakis, et al (European Respiratory Review, 2016).

The study

• Authors: A.C. Bibby, S. Tsim, N. Kanellakis, H. Ball, D.C. Talbot, K.G. Blyth, N.A. Maskell, I. Psallidas
• Journal: European Respiratory Review
• Published: 2016;25(142):472-486
• Type of article: Review
• Cited by: 222 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years.This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

Copyright ©ERS 2016.

In plain English

This article was a narrative review, not an original study. It summarised published evidence on the causes, symptoms, diagnosis and treatment of malignant pleural mesothelioma. The authors described the disease as mainly caused by asbestos exposure, often over 40 years earlier. They said risk depends on fibre type (chrysotile or amphibole) and on how heavy and long exposure was. They also noted exposure outside the job, for example in wives who laundered asbestos workers' clothes. Citing other studies, they reported median survival of 8 to 14 months from diagnosis. In one cited trial, median survival was 12.1 months with pemetrexed and cisplatin versus 9.3 months with cisplatin alone. In another (MAPS), adding bevacizumab to chemotherapy gave median overall survival of 18.8 months (95% CI 15.9 to 22.6) versus 16.1 months (95% CI 14.0 to 17.9). They reported that the only randomised trial of extrapleural pneumonectomy (MARS) suggested possible harm. They said no diagnostic blood or fluid marker had yet proved reliable. The authors concluded that treatment options remain limited, but the bevacizumab trial gave hope this may be changing.

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 (article number 4 in a journal series on pleural diseases); no original data
• Who was studied: No study population of its own; the review drew on published literature about patients with malignant pleural mesothelioma
• Exposure: Asbestos as the main cause: chrysotile (white) and the amphiboles crocidolite (blue), amosite (brown), anthophyllite, actinolite and tremolite. Risk was described as depending on fibre type and on the heaviness and duration of exposure. Other causes named were erionite, chest wall radiation and simian virus 40; the authors said the evidence that simian virus 40 causes the disease is weak.
• Main results:
  • The review stated that most cases follow asbestos exposure that often occurred more than 40 years earlier (citing other sources)
  • Exposure outside the workplace itself can occur, for example in wives of asbestos workers who laundered their clothes (citing other sources)
  • Median survival from diagnosis ranges from 8 to 14 months, with a male-to-female ratio of 4:1 (citing other sources)
  • In a cited phase III trial of 448 previously untreated participants, median survival was 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone (p=0.02)
  • In the cited MAPS trial (448 participants), median overall survival was 18.8 months (95% CI 15.9 to 22.6) with bevacizumab added to chemotherapy versus 16.1 months (95% CI 14.0 to 17.9) with chemotherapy alone (p=0.017)
  • In the cited MARS randomised feasibility trial, extrapleural pneumonectomy was associated with an adjusted hazard ratio for death of 2.75 (95% CI 1.21 to 6.26; p=0.016), which the review described as potential harm
  • In a cited meta-analysis of 4491 individuals, 1026 of whom had the disease, serum mesothelin had a sensitivity of 32% at 95% specificity, which the authors judged insufficient for diagnosis
• The authors' conclusion: The authors concluded that the disease is complex and hard to diagnose and that treatment options remain limited. They said the recent bevacizumab trial has given hope that this may be changing, and that future treatment is likely to be highly individualised.
• Limitations the authors state:
  • The review did not cover the evidence on the different biopsy approaches
  • Precise incidence figures are hard to determine because the disease is likely under-reported in areas of low incidence
  • The biomarker studies reviewed were weakened by retrospective designs, selected patient groups, inappropriate controls and inconsistent methods

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, Asbestos Exposure, Incidence, Epidemiology, Biomarker, Palliative Care, Pleural Effusion, Chemotherapy.

Related studies

• Malignant pleural mesothelioma: an update on diagnosis and treatment options — S. Kondola, D. Manners, et al. (2016)
• Updates in the diagnosis and treatment of malignant pleural mesothelioma — D. Katzman, D.H. Sterman (2018)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare investigation of treatment patterns and overall survival — J.L. Beebe-Dimmer, J.P. Fryzek, et al. (2016)
• Local recurrence model of malignant pleural mesothelioma for investigation of intrapleural treatment — I. Opitz, D. Lardinois, et al. (2007)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)

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