Medical treatment of mesothelioma: anything new?

Our plain-English summary of Medical treatment of mesothelioma: anything new?, by N. Takigawa, K. Kiura, T. Kishimoto (Current Oncology Reports, 2011).

The study

• Authors: N. Takigawa, K. Kiura, T. Kishimoto
• Journal: Current Oncology Reports
• Published: 2011;13(4):265-71
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In the present report, we review the current standard and investigational treatments of malignant pleural mesothelioma (MPM). Several studies have reported the use of gemcitabine and cisplatin as an induction chemotherapy in combination with extrapleural pneumonectomy (EPP) and thoracic radiation in a combined-modality approach for resectable MPM. Since the combination of cisplatin with pemetrexed was applied as the standard first-line regimen for unresectable MPM, the combination as an induction chemotherapy regimen has been proven effective in phase 2 trials. In addition, intensity-modulated radiation therapy and proton therapy have been introduced as new radiation methods into the combined modality. Hyperthermic intraoperative chemotherapy following EPP appears effective with acceptable toxicity. In addition, clinical studies that include molecular targeting agents, immunotherapy, and gene therapy have all been conducted. Thus, although there are numerous hopeful treatments for MPM, the benefits of these regimens remain to be proven in a randomized clinical setting.

In plain English

This article was a review, not a new study. The authors described standard and experimental treatments for malignant pleural mesothelioma (MPM), drawing on studies by other researchers. They did not say how those studies were chosen. For tumors that could be removed by surgery, they described treatment combining chemotherapy, extrapleural pneumonectomy (EPP) and radiation. In one cited trial, patients who completed all three had a median survival of 29.1 months. A cited systematic review reported median survival after EPP ranging from 9.4 to 27.5 months across studies. For tumors that could not be removed, the authors described cisplatin with pemetrexed as the standard first chemotherapy. A cited trial found that adding chemotherapy to symptom control gave no significant benefit in survival or quality of life. The authors also listed targeted drugs, immune treatments and gene therapies, noting that the targeted drugs had never been proven in randomized studies. The authors concluded that many treatments look hopeful but their benefits remain to be proven in randomized trials. Asbestos appeared only as background.

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 treatment studies and clinical trials; no search method described
• Who was studied: Patients with malignant pleural mesothelioma, both resectable and unresectable, as studied in trials by other researchers; the authors do not state how many studies were reviewed or how they were selected
• Exposure: Not studied. The introduction mentions in general terms that workplace asbestos exposure has given rise to lung fibrosis, lung cancer and MPM; no fiber types are named.
• Main results:
  • In a cited multicenter phase 2 trial of cisplatin plus pemetrexed before EPP and radiation, patients who completed all three treatments had a median survival of 29.1 months and a 2-year survival rate of 61.2% (median survival in the overall population was 16.8 months)
  • A cited systematic review of 34 studies of EPP for MPM reported median overall survival ranging from 9.4 to 27.5 months
  • A cited retrospective study (Flores et al.) reported median survival of 12 months for EPP patients (n=385) and 14 months for pleurectomy/decortication patients (n=278)
  • In a cited phase 2 study of hyperthermic intraoperative cisplatin perfusion after EPP, median survival of 121 patients was 12.8 months
  • The authors describe cisplatin with pemetrexed as the standard first-line regimen for MPM
  • In a cited trial of 409 MPM patients, adding chemotherapy (mitomycin, vinblastine and cisplatin, or vinorelbine) to active symptom control gave no significant benefit in overall survival or quality of life (median survival 7.6 months with symptom control alone vs 8.5 months with chemotherapy)
  • In a cited randomized phase 2 trial, adding bevacizumab to gemcitabine plus cisplatin gave progression-free survival of 6.9 vs 6.0 months and median survival of 15.6 vs 14.7 months (bevacizumab vs placebo); neither difference was statistically significant
  • The authors state that the benefits of molecular-targeting agents had not been proven in randomized studies
• The authors' conclusion: The authors concluded that although there are numerous hopeful treatments for MPM, their benefits remain to be proven in randomized clinical trials

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Gemcitabine, Cisplatin, Chemotherapy, Extrapleural Pneumonectomy (EPP), Pemetrexed (Alimta), Unresectable.

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