Malignant pleural mesothelioma: current concepts in treatment

Our plain-English summary of Malignant pleural mesothelioma: current concepts in treatment, by A. Tsiouris, R.K. Walesby (Nature Clinical Practice. Oncology, 2007).

The study

• Authors: A. Tsiouris, R.K. Walesby
• Journal: Nature Clinical Practice. Oncology
• Published: 2007;4(6):344-52
• Type of article: Review
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a primary and locally aggressive tumor of the pleura. A well defined causal relationship with asbestos exposure, and an overwhelming media interest in the use of asbestos in industrialized countries after World War II, has produced a high level of awareness of this disease. With a peak incidence of MPM expected in Europe, Australia, and the US within the next 15 years, and the failure of current treatment approaches to offer long-term survival and improve quality of life, new therapeutic regimens are warranted. The effects of surgery in terms of survival and symptomatic relief have yet to be defined because of a lack of randomized trials. The role of radiotherapy in the treatment of MPM remains controversial, as the radiosensitivity of malignant mesothelial cells is modest. MPM response to chemotherapy is comparatively poor. The combination of pemetrexed and cisplatin chemotherapy has achieved the best objective responses. Presently, a multimodal approach is considered to be the cornerstone of treatment of MPM. Important ongoing international and national trials are addressing the roles of chemotherapy (e.g. the EAP and MS01 trial), radical surgery (e.g. the MARS trial) and radiotherapy (e.g. the SAKK group phase III study).

In plain English

This article was a review, not a new study. The authors searched MEDLINE for English-language articles from January 1990 to August 2006 on surgery, radiotherapy and chemotherapy for malignant pleural mesothelioma, a tumor of the pleura that they described as strongly associated with asbestos exposure. They found no randomized trials comparing the two main operations, extrapleural pneumonectomy and pleurectomy/decortication, or comparing surgery with other treatments. In one randomized trial they reviewed, none of 20 patients given preventive radiation after thoracoscopy had tract seeding (tumor spreading along the path of the procedure), compared with 8 (40%) of the control group. Another trial reported tract tumors in 2 (7%) of 28 radiation patients versus 3 (10%) of 30 controls (P = 0.53). A phase III trial of 456 patients reported median survival of 12.1 months with cisplatin plus pemetrexed versus 9.3 months with cisplatin alone. The authors concluded that current treatments offer only marginal clinical benefit and that the role of surgery needs to be assessed in controlled randomized studies.

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: Review of published literature (MEDLINE search, January 1990 to August 2006) on treatment of malignant pleural mesothelioma; no new patient data
• Who was studied: Published trials, prospective studies, reviews and editorials on surgical and/or radiochemotherapeutic treatment of malignant pleural mesothelioma, English-language only; ongoing trials were also sought from major thoracic oncology centers
• Exposure: The review concerned treatments (surgery, radiotherapy, chemotherapy), not asbestos exposure. Asbestos was described as background: the disease is strongly associated with asbestos, and the authors cited reports that both chrysotile and the amphiboles are causative, with the amphiboles more closely associated
• Main results:
  • The authors found no randomized trials comparing extrapleural pneumonectomy (EPP) with pleurectomy/decortication (P/D), or comparing surgery with other treatments
  • Sugarbaker and co-authors, in a series of 183 patients who underwent EPP with or without chemotherapy, reported a 5-year survival rate of 15%, postoperative mortality of 3.8% and postoperative morbidity of 50%
  • Boutin et al. randomized 40 patients after thoracoscopy. None of the 20 who received prophylactic radiation had tract seeding, compared with 8 (40%) of the control group (P <0.001)
  • Bydder and colleagues reported procedure tract metastasis in 2 (7%) of 28 patients given prophylactic radiation versus 3 (10%) of 30 controls (P = 0.53)
  • In a phase III trial of 456 patients, cisplatin plus pemetrexed gave longer median survival than cisplatin alone (12.1 versus 9.3 months; P = 0.02) and a higher response rate (41.3% versus 16.7%; P <0.0001)
  • Bottomley et al., in 250 patients with unresectable disease, reported median survival of 8.8 months with cisplatin alone versus 11.4 months with cisplatin plus raltitrexed (P = 0.048)
• The authors' conclusion: The authors concluded that current treatment regimens offer only marginal clinical benefit, that a multimodal approach will be the cornerstone of future treatment though randomized trials are still needed, and that the role of surgery must be assessed in controlled randomized studies
• Limitations the authors state:
  • Only English-language articles were considered
  • The search was limited to 1990 to 2006 because staging, classification and treatment of the disease varied over the years
  • The authors stated that retrospective data on both operations were relatively poor and came mostly from case series

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, Pleura, Asbestos Exposure, Quality of Life, Mesothelial Cells, Chemotherapy, Pemetrexed (Alimta), Cisplatin.

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