Malignant pleural mesothelioma: recent developments

Our plain-English summary of Malignant pleural mesothelioma: recent developments, by K. Sinn, B. Mosleh, M.A. Hoda (Current Opinion in Oncology, 2021).

The study

• Authors: K. Sinn, B. Mosleh, M.A. Hoda
• Journal: Current Opinion in Oncology
• Published: 2021;33(1):80-86
• Type of article: Review
• Cited by: 55 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose Of Review: Malignant pleural mesothelioma (MPM) is a rare, but aggressive tumor with still poor prognosis. In this article, we focus on recent developments in the management of MPM including diagnosis, staging, biomarkers, and treatment strategies.

Recent Findings: Molecular markers such as programmed death-ligand 1 (PDL-1), Breast Cancer gene 1-associated protein gene, and cyclin-dependent kinase inhibitor 2A (CDKN2A) have prognostic impact and should be considered for assessment in patient samples. In addition to histological subtype and tumor pattern, tumor volumetry plays an increasing important role in staging, assessment of treatment response, and prediction of survival. Several new blood-based biomarkers have been recently reported including peripheral blood DNA methylation, microRNAs, fibulin, and high-mobility group box 1, but have not been established in clinical routine use yet. Regarding treatment, targeted therapies, immunotherapy, and vaccination are considered as new promising strategies. Moreover, extended pleurectomy/decortication is favored over extrapleural pneumonectomy (EPP) and intensity-modulated radiotherapy represents a possible approach in combination with EPP and pleurectomy/decortication. Intracavitary treatment options are promising and deserve further investigations.

Summary: Overall, there has not been a real breakthrough in the treatment of MPM. Further research and clinical trials are needed to evaluate outcome and to identify new potential treatment candidates.

In plain English

This article was a narrative review of recent developments in the management of malignant pleural mesothelioma (MPM), covering diagnosis, staging, biomarkers and treatment. It reported no new patient data; its figures come from earlier studies it cited. In its background the review noted, citing other work, that MPM incidence is linked to asbestos importation and use. The authors named PDL-1, BAP1 and CDKN2A as relevant molecular markers. They said measuring tumor volume plays an increasing role in staging, and noted that several blood-based biomarkers have been reported but are not yet established in routine clinical use. Among the cited results, adding bevacizumab to first-line chemotherapy increased overall survival by 2.7 months. A phase II vaccine trial reported median overall survival of 22.8 months with the vaccine versus 18.3 months in controls. Cited reviews reported perioperative mortality of 2.9% for pleurectomy/decortication versus 6.8% for extrapleural pneumonectomy. The authors concluded that extended pleurectomy/decortication is favored. They also concluded that there has not been a real breakthrough in MPM treatment and that more research and trials are 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 recent literature
• Who was studied: No study population of its own; the review covers published research on patients with malignant pleural mesothelioma
• Exposure: No exposure was studied. The background section, citing other work, says MPM incidence is linked to asbestos importation and use
• Main results:
  • The authors identified PDL-1, BAP1 and CDKN2A as relevant molecular markers in MPM
  • Tumor volumetry (measuring tumor volume) plays an increasing role in staging, according to the authors
  • New blood-based biomarkers (peripheral blood DNA methylation, microRNAs, fibulin, high-mobility group box 1) have been reported but are not established in routine clinical use
  • In a cited trial, adding bevacizumab to first-line platinum/antifolate chemotherapy increased overall survival by 2.7 months
  • In a cited phase II trial of the WT1 vaccine galinpepimut-S given with multimodality treatment including radical surgery, median overall survival was 22.8 months in the vaccine group versus 18.3 months in the control group
  • Cited reviews reported perioperative mortality of 2.9% for pleurectomy/decortication versus 6.8% for extrapleural pneumonectomy (EPP), and morbidity of 27.9% versus 62%
• The authors' conclusion: The authors concluded that extended pleurectomy/decortication is favored over EPP. They also concluded that there has not been a real breakthrough in the treatment of MPM and that further research and clinical trials are needed
• Limitations the authors state:
  • The authors note that the choice between surgical procedures remains debated because no randomized trials compare long-term results. This is a limitation of the evidence they reviewed, not of their own method.

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, Prognosis, Staging, Biomarker, CDKN2A, Histological Subtype, Immunotherapy, Pleurectomy/Decortication (P/D).

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• Immunotherapy for malignant pleural mesothelioma. Current status and future prospects — R.M. Wong, I. Ianculescu, et al. (2014)
• Repositioning PARP inhibitors in the treatment of thoracic malignancies — F. Passiglia, M.L. Reale, et al. (2021)
• Immune checkpoint inhibitors a new player in the therapeutic game of mesothelioma: New reality with new challenges — K. Parikh, L.E.L. Hendriks, et al. (2021)

Browse more research in Current Opinion in Oncology, or return to medical research.