Malignant pleural mesothelioma: the standard of care and challenges for future management

Our plain-English summary of Malignant pleural mesothelioma: the standard of care and challenges for future management, by J.P. van Meerbeeck, A. Scherpereel, V.F. Surmont, et al (Critical Reviews in Oncology/hematology, 2011).

The study

• Authors: J.P. van Meerbeeck, A. Scherpereel, V.F. Surmont, P. Baas
• Journal: Critical Reviews in Oncology/hematology
• Published: 2011;78(2):92-111
• Type of article: Review
• Cited by: 98 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This review addresses the management of MPM. In an introductory section, the etiology, epidemiology, presentation, diagnosis and staging of MPM will be reviewed. The evidence was collected by a systematic analysis of the literature (2000-2009) using the databases Medline (National Library of Medicine, USA), Embase (Elsevier, Netherlands), Cochrane Library (Great Britain), National Guideline Clearinghouse (USA), HTA Database (International Network of Agencies for Health Technology Assessment - INAHTA), NIH database (USA), International Pleural Mesothelioma Program - WHOLIS (WHO Database) with the following keywords and filters: pleura, cancer, mesothelioma, guidelines, treatment, surgery, chemotherapy, radiotherapy, palliation, supportive care, pleurodesis, review.

2010 Elsevier Ireland Ltd. All rights reserved.

In plain English

This article was a review of how malignant pleural mesothelioma (MPM), a cancer of the lining around the lung, is managed. The authors searched several medical databases for literature from 2000 to 2009. They also covered causes, diagnosis and staging, and summarised five sets of guidelines from national, provincial and European bodies. In their background section, the authors stated that asbestos is the principal cause of MPM. They wrote that the share attributable to occupational asbestos exposure is higher than 80% in men and lower than 40% in women, and that untreated patients survive a median of 6 to 9 months. Among the studies reviewed, two randomised trials reported an improvement in median survival of 2.6 to 2.8 months when cisplatin was combined with pemetrexed or raltitrexed, compared with cisplatin alone. Multicentre trials in selected patients combined chemotherapy, extrapleural pneumonectomy and radiotherapy, and reported median survival of 17 to 20 months. The authors described the role of surgery as controversial. They noted that no randomised study had shown a survival gain from second-line chemotherapy. The authors concluded that active, though palliative, chemotherapy is now available.

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 the literature on management of MPM, based on a systematic search of databases for 2000 to 2009, plus a summary of guidelines from several organisations
• Who was studied: Published studies and guidelines on malignant pleural mesothelioma; the review itself enrolled no patients
• Exposure: The review is about treatment rather than exposure. Its background section names asbestos as the principal cause of MPM and mentions environmental exposure, generally to tremolite, in some areas.
• Main results:
  • Background stated by the authors: the fraction of MPM attributable to occupational asbestos exposure is higher than 80% in men and lower than 40% in women
  • Background stated by the authors: mean latency of MPM after asbestos exposure is around 40 years (range 15 to 67 years)
  • Median survival of untreated cases is 6 to 9 months, with less than 5% surviving 5 years
  • In two reviewed randomised trials, combining cisplatin with an antifolate (pemetrexed or raltitrexed) improved median survival by 2.6 to 2.8 months compared with cisplatin alone
  • In a reviewed randomised trial of 61 patients, drain-site radiotherapy to prevent tumour spread along procedure tracts showed no difference in tract metastatic recurrence compared with best supportive care
  • In experienced centres, operative mortality for extrapleural pneumonectomy has fallen to around 5%, while morbidity remains around 50%
  • Reviewed multicentre phase 2 trials in highly selected patients combined neoadjuvant chemotherapy, extrapleural pneumonectomy and postoperative radiotherapy, and reported a median survival of 17 to 20 months
  • After failure of first-line chemotherapy, no randomised study had yet shown a gain in overall survival or quality of life
  • In a reviewed randomised phase II trial, median survival with bevacizumab plus chemotherapy was 15.6 months versus 14.7 months without it, a difference that was not statistically significant
  • Guidelines summarised in the review came from the British Thoracic Society, the French-speaking SPLF, an Ontario provincial group, ESMO, and the ERS jointly with the ESTS
• The authors' conclusion: The authors concluded that therapeutic nihilism is no longer justified because active, though palliative, chemotherapy is available; that symptom control remains the cornerstone of care; that only a small proportion of patients might benefit from more aggressive treatment; and that patients should be enrolled in randomised trials whenever possible
• Limitations the authors state:
  • The authors stated that early reports of MPM treatment outcomes suffered from biases, including unproven cases, small samples, variable inclusion criteria and per-protocol analyses of surgical series
  • The authors stated that, without comparative data, no formal advice could be given on the relative performance of staging investigations
  • The authors stated that the role of surgery in MPM remains controversial and should be further explored

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, Etiology, Epidemiology, Staging, Pleura, Mesothelioma, Chemotherapy, Pleurodesis.

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