Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies

Our plain-English summary of Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies, by M. Pistolesi, J. Rusthoven (Chest, 2004).

The study

• Authors: M. Pistolesi, J. Rusthoven
• Journal: Chest
• Published: 2004;126(4):1318-29
• Type of article: Review
• Cited by: 86 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The diagnosis and management of malignant pleural mesothelioma are major challenges that often frustrate both patient and clinician alike. Occupational asbestos exposure to crocidolite or amosite forms of the fiber is the most important known risk factor in North America and Western Europe. Other mineral fibers such as erionite, a naturally occurring fibrous zeolite crystal, are associated with mesothelioma in volcanic tuffs of the Cappadocia region of central Anatolia in Turkey. In addition, other possible factors such as the presence of simian virus 40 and genetic susceptibility have been associated recently with the development of mesothelioma in animal models. These latter findings are increasing our understanding of this disease. In addition, the discovery of elevated levels of various markers such as folic acid receptor alpha, cyclooxygenase 2, and multidrug resistance proteins 1 and 2 in mesothelioma tissue have opened up new areas of potential diagnostic and therapeutic importance. However, traditional treatment modalities--surgery, radiotherapy, and chemotherapy--have evolved slowly, and few gains in therapeutic efficacy have occurred. Recently, however, continuing research efforts have led to novel treatment strategies that are changing the way clinicians view a disease that has traditionally been managed with almost universal therapeutic nihilism. This review explores our current knowledge of this disease and presents current and novel therapeutic strategies.

In plain English

This article was a review, not a new study. The authors summarized published research on malignant pleural mesothelioma: how common it is, its causes and biology, diagnosis, staging and treatment. Drawing on earlier studies, they described occupational exposure to crocidolite or amosite asbestos as the most important known risk factor in North America and Western Europe. They wrote that amphiboles such as crocidolite and amosite appeared more carcinogenic in animal models and tissue culture than chrysotile. They also described erionite, a mineral fiber associated with mesothelioma in the Cappadocia region of Turkey. They cited reports that about 80% of patients with this disease had a history of asbestos exposure, that about 10% of people with asbestos exposure developed mesothelioma, and a mean time from first exposure to death of 48.7 years (range 14 to 72 years). On treatment, they wrote that surgery and radiation had not clearly improved survival. They described a phase III trial in which median survival was 12.1 months with pemetrexed plus cisplatin and 9.3 months with cisplatin alone. The authors concluded that this combination would likely become a major part of standard care for advanced disease.

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 literature
• Who was studied: No study population of its own; the article reviewed published research on malignant pleural mesothelioma
• Exposure: Reviewed risk factors: occupational asbestos exposure (crocidolite, amosite; compared with chrysotile), erionite, simian virus 40 and genetic susceptibility
• Main results:
  • Citing earlier work, the review stated that amphiboles (crocidolite, amosite) appear more carcinogenic and mutagenic than chrysotile in animal models and tissue culture
  • The review described erionite as associated with mesothelioma in volcanic tuffs of the Cappadocia region, Turkey
  • Citing earlier studies: about 80% of patients with malignant pleural mesothelioma had a history of asbestos exposure; about 10% of those with asbestos exposure acquired mesothelioma
  • Citing an earlier study: latency from initial exposure to death reported up to 72 years (mean 48.7 years, range 14 to 72 years)
  • The review stated that neither extrapleural pneumonectomy nor pleurectomy/decortication appears to offer a significant improvement in survival
  • The review stated that radiation therapy seems to have a role in palliation but no real impact on survival
  • In a cited phase III trial, median survival was 12.1 months with pemetrexed plus cisplatin vs 9.3 months with cisplatin alone
• The authors' conclusion: The authors concluded that pemetrexed combined with cisplatin will likely become a major component of the standard of care for patients with advanced disease

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, Asbestos Exposure, Crocidolite, Amosite, Mineral Fiber, erionite, Zeolite, Mesothelioma.

Related studies

• Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum — Y.K. Lee, H.J. Jun, et al. (2013)
• Survey and biological insights of pemetrexed-related therapeutic improvement in mesothelioma: The Nancy Centre of Biological Resources' Mesothelioma Cohort — F. Vlastos, G. Hillas, et al. (2009)
• Current issues in malignant pleural mesothelioma evaluation and management — J. Ai, J.P. Stevenson (2014)
• Thymidylate synthase and folyl-polyglutamate synthase are not clinically useful markers of response to pemetrexed in patients with malignant pleural mesothelioma — D.E. Lustgarten, C. Deshpande, et al. (2013)
• Current management strategies for peritoneal mesothelioma — K.K. Turaga, M. Deraco, et al. (2017)
• Combined chemotherapy with cytotoxic and targeted compounds for the management of human malignant pleural mesothelioma — R.E. Favoni, T. Florio (2011)

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