Malignant pleural mesothelioma: update on treatment options with a focus on novel therapies

Our plain-English summary of Malignant pleural mesothelioma: update on treatment options with a focus on novel therapies, by A.R. Haas, D.H. Sterman (Clinics in Chest Medicine, 2013).

The study

• Authors: A.R. Haas, D.H. Sterman
• Journal: Clinics in Chest Medicine
• Published: 2013;34(1):99-111
• Type of article: Review
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

There is evidence that improved treatments of malignant pleural mesothelioma are increasing the quality and quantity of life for patients with mesothelioma. Multimodality treatment programs that combine maximal surgical cytoreduction with novel forms of radiation therapy and more effective chemotherapy combinations may offer significant increases in survival for certain subgroups of patients with mesothelioma. Lung-sparing surgery may allow improvements in pulmonary function after surgery-based multimodality therapy, and potential longer overall survival than that seen with extrapleural pneumonectomy. Experimental treatments provide hope for all patients with mesothelioma, and in the future may be combined with standard therapy in multimodality protocols.

Copyright © 2013 Elsevier Inc. All rights reserved.

In plain English

This article was a review. The authors described standard and experimental treatments for malignant pleural mesothelioma, including surgery, chemotherapy, radiation, immunotherapy and gene therapy. They drew on published trials, including several by their own University of Pennsylvania group. The review noted that asbestos exposure is the predominant cause but did not study exposure. It described a 2003 trial by Vogelzang and colleagues in 456 patients not previously treated with chemotherapy. That trial reported response rates of 41.3% with pemetrexed plus cisplatin versus 16.7% with cisplatin alone, and median survival of 12.1 versus 9.3 months. The review stated that in most surgical series of extrapleural pneumonectomy, median survival was under 2 years. Early trials of imatinib, gefitinib and erlotinib failed to show significant clinical benefit; among other targeted agents tried, only tetrathiomolybdate had shown any benefit in human trials. In the authors' own small gene therapy trials, some patients had stable disease or partial responses. The authors concluded that combined treatment programs may offer significant increases in survival for certain subgroups, and that gene therapy had not yet reached routine clinical practice.

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 treatment options for malignant pleural mesothelioma, covering standard and experimental therapies
• Who was studied: No new patients were studied. The review covers published and ongoing treatment trials in patients with malignant pleural mesothelioma, including trials by the authors' own group at the University of Pennsylvania.
• Exposure: Not studied. The review concerns treatments; asbestos is mentioned only as the predominant cause of mesothelioma.
• Main results:
  • In a phase III trial reviewed (Vogelzang and colleagues, 2003; 456 chemotherapy-naive patients), response rates were 41.3% with pemetrexed/cisplatin versus 16.7% with cisplatin alone.
  • In the same reviewed trial, median survival was 12.1 months with pemetrexed/cisplatin versus 9.3 months with cisplatin only.
  • The review stated that in most surgical series of extrapleural pneumonectomy (EPP), median survival was less than 2 years, with average 5-year survival of 10% to 20%.
  • In a reviewed series of IMRT after EPP, 6 of 13 patients developed fatal pneumonitis.
  • Early-phase trials of imatinib, gefitinib and erlotinib were reported to show no significant clinical benefit in malignant pleural mesothelioma.
  • Among the other targeted agents trialed (bevacizumab, thalidomide and tetrathiomolybdate), the review reported that only tetrathiomolybdate had shown any benefit in human trials.
  • In the authors' group's suicide gene therapy trials (Ad.HSVtk/GCV), dose-related gene transfer was shown in 23 of 30 patients.
  • In the authors' group's single-dose interferon-beta gene transfer trial (10 patients), 4 showed disease stability and/or regression at day 60.
  • In the authors' group's interferon-alfa-2b gene transfer trial, at day 60, 3 subjects had progressive disease, 4 had stable disease and 2 had partial responses.
• The authors' conclusion: The authors concluded that multimodality programs combining maximal surgery with newer radiation and chemotherapy may offer significant survival increases for certain subgroups of patients. They also concluded that novel treatments such as gene therapy had not yet reached routine clinical practice.
• Limitations the authors state:
  • The authors noted that no randomized trials show the efficacy of radiation given after surgery, although multimodality approaches commonly include it.
  • The authors noted there is insufficient evidence to recommend second-line chemotherapy as standard treatment.

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, Mesothelioma, Cytoreductive Surgery, Chemotherapy, Multimodal Therapy, Overall Survival, Extrapleural Pneumonectomy (EPP).

Related studies

• Novel intrapleural therapies for malignant diseases — A.R. Haas, D.H. Sterman (2012)
• 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)
• Novel and Future Treatment Options in Mesothelioma: A Systematic Review — D. Štrbac, V. Dolžan (2022)
• Novel targeted therapies and vaccination strategies for mesothelioma — M. Bagia, A.K. Nowak (2011)
• Novel approaches for the treatment of unresectable malignant pleural mesothelioma: A focus on immunotherapy and target therapy (Review) — E. Rijavec, F. Biello, et al. (2022)

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