Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG)

Our plain-English summary of Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG), by M.A. Hoda, T. Klikovits, M. Arns, et al (Wiener Klinische Wochenschrift, 2016).

The study

• Authors: M.A. Hoda, T. Klikovits, M. Arns, K. Dieckmann, S. Zöchbauer-Müller, C. Geltner, B. Baumgartner, P. Errhalt, B. Machan, W. Pohl, J. Hutter, J. Eckmayr, M. Studnicka, M. Flicker, P. Cerkl, W. Klepetko
• Journal: Wiener Klinische Wochenschrift
• Published: 2016;128(17-18):618-26
• Type of article: Consensus statement
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Treatment of malignant pleural mesothelioma (MPM) depends on performance status of the patient, tumor stage, and histological differentiation. Chemotherapy (CHT) can be administered as first- and second-line treatment in unresectable MPM or as neoadjuvant or adjuvant treatment before or after surgery. A combination of an antifolate and platinum-based CHT is the only approved standard of care. Several targeted and immunotherapies are in evaluation and further studies are warranted to determine the therapeutic value of these new treatment options. Radiotherapy (RT) can be considered either as adjuvant treatment after surgery or for palliation of pain-related tumor growth. Recent data support the use of RT in a neoadjuvant setting. Macroscopic complete resection by pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) is indicated in selected patients with good performance status. Surgery should only be applied as part of a multimodality treatment (MMT) in combination with chemo- and/or radiotherapy. In a large number of cases, palliative attempts are needed to improve quality of life and to achieve symptom control.

In plain English

This was a consensus report of the Austrian Mesothelioma Interest Group (AMIG), part 2 of a series, on treating malignant pleural mesothelioma. It was not a new study of patients. The authors drew on published studies by others to describe chemotherapy, radiotherapy, surgery, combined treatment and palliative care. For first-line chemotherapy they described 4–6 cycles of cisplatin and pemetrexed. Six cycles were favored only with a good response and no grade 3 or 4 toxicities, and carboplatin was an acceptable alternative to cisplatin. They wrote that no standard second-line therapy exists and recommended enrolling patients in clinical trials. They gave radiotherapy dose schedules for several settings. They stated that surgery aimed at macroscopic complete resection should only be part of multimodality treatment with chemotherapy and/or radiotherapy. They also described palliative surgery. Citing European guidelines, they wrote that curative extrapleural pneumonectomy should be done only at high-volume centers within a clinical study. Sterile talc was the preferred pleurodesis agent. They noted that surgical evidence comes mainly from institutional reports and that quality-of-life data are scarce. They concluded that no worldwide accepted surgical therapy exists and that pooling patients in specialized centers is mandatory.

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: Consensus report (expert narrative review with recommendations) of the Austrian Mesothelioma Interest Group
• Who was studied: No patients were studied. The recommendations concern patients with malignant pleural mesothelioma (MPM). The report was written by 16 authors from Austrian hospitals on behalf of AMIG.
• Main results:
  • For first-line chemotherapy, the authors described 4–6 cycles of cisplatin and pemetrexed.
  • Six cycles were favored only with good overall response rates and no grade 3 or 4 toxicities.
  • Carboplatin was described as an acceptable alternative to cisplatin.
  • No standard second-line therapy exists; the authors recommended enrolling patients in clinical trials.
  • For radiotherapy after surgery, the authors stated a dose of 50–54 Gy given in once-daily fractions of 1.8–2.0 Gy.
  • Surgery for MPM was described as having either curative or palliative intent.
  • The authors described macroscopic complete resection by P/D or EPP as indicated in selected patients. They stated that surgery should only be applied as part of a multimodality treatment with chemotherapy and/or radiotherapy.
  • Citing ERS/ESTS guidelines, the authors stated that extrapleural pneumonectomy with curative intent should only be performed at high-volume centers within a clinical study.
  • For palliation of pleural effusion, sterile talc powder was named the preferred agent for pleurodesis.
• The authors' conclusion: The authors concluded that no worldwide accepted surgical therapy exists. They stated that the choice of procedure depends on tumor stage, clinical presentation and institutional expertise, and that pooling patients in specialized centers is mandatory.
• Limitations the authors state:
  • Large randomized surgical trials are lacking; only institutional reports with differing protocols and techniques are available to compare P/D and EPP.
  • Little data exist on quality of life during and after 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, Performance Status, Chemotherapy, Unresectable, Antifolate, Pleurectomy/Decortication (P/D), Extrapleural Pneumonectomy (EPP).

Related studies

• Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG) — C. Geltner, P. Errhalt, et al. (2016)
• Management of malignant pleural mesothelioma - part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database — T. Klikovits, M.A. Hoda, et al. (2016)
• Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group — D. Rice, V. Rusch, et al. (2011)
• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
• Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group — A.N. Husain, T. Colby, et al. (2013)
• The Thoracic Surgery Service at Memorial Sloan Kettering Cancer Center — V.W. Rusch (2015)

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