Modern management of malignant pleural mesothelioma

Our plain-English summary of Modern management of malignant pleural mesothelioma, by S.C. Patel, J.E. Dowell (Lung Cancer, 2016).

The study

• Authors: S.C. Patel, J.E. Dowell
• Journal: Lung Cancer
• Published: 2016;7:63-72
• Type of article: Review
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a deadly disease that produces a significant worldwide health care burden. The majority of cases are associated with prior asbestos exposure, but recent studies have identified a possible genetic predisposition in a minority of patients. Historically, obtaining a pathologic diagnosis of MPM was challenging, but with current pathological techniques, a secure diagnosis is possible in the majority of patients. Curative therapy for MPM remains elusive, and the primary treatment option for fit patients is platinum-based chemotherapy. Encouraging recent reports suggest that there may be a benefit to the addition of bevacizumab to standard chemotherapy as well as with the use of immune checkpoint inhibitors in MPM. Selected patients may be considered for aggressive surgical approaches, but there is considerable controversy regarding the true benefit of surgery and multimodality therapy in this disease.

In plain English

This article is a review: the authors summarized published research on the causes, diagnosis and treatment of malignant pleural mesothelioma (MPM). They reported that an asbestos exposure is identified in up to 80% of cases, that the time from exposure to disease can range from 20 to 70 years, and that up to 20% of patients have no prior asbestos exposure. Among the trials the authors reviewed, one in 456 patients found longer median overall survival with cisplatin plus pemetrexed than with cisplatin alone (12.1 versus 9.3 months). Another, in 448 patients, found longer median overall survival when bevacizumab was added to cisplatin and pemetrexed (18.8 versus 16.1 months). The authors called the benefit of aggressive surgery controversial. In the MARS feasibility study of 50 patients that they described, median survival was 14.4 months with extrapleural pneumonectomy and 19.5 months without it. The authors concluded that most fit patients are offered platinum-based chemotherapy that modestly improves survival, and that the prognosis for most patients remains poor.

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 on malignant pleural mesothelioma (no new data collected by the authors)
• Who was studied: Published studies, trials and guidelines on patients with malignant pleural mesothelioma; the review does not describe how studies were selected
• Exposure: Occupational or environmental asbestos and mineral fiber exposure, as the main risk factor described; ionizing radiation and genetic mutations (BAP1) are also discussed. No specific fiber types are named.
• Main results:
  • The review reports, from other studies, that the latency from exposure to disease can range from 20 to 70 years.
  • The review states that up to 20% of MPM patients have no prior asbestos exposure.
  • From a cited study: the prevalence of germline BAP1 mutations was 6% in a large asbestos-exposed group with mesothelioma and a family history of cancer.
  • From a cited Phase III trial in 456 treatment-naive MPM patients who were not surgical candidates: median overall survival was 12.1 months with cisplatin plus pemetrexed versus 9.3 months with cisplatin alone (P=0.02).
  • From a cited Phase III trial (MAPS) in 448 untreated, unresectable MPM patients: median overall survival was 18.8 months with bevacizumab added to cisplatin and pemetrexed versus 16.1 months with chemotherapy only (P=0.012).
  • From the cited MARS feasibility study of 50 patients: median survival was 14.4 months in the extrapleural pneumonectomy (EPP) group and 19.5 months in the no-EPP group. The hazard ratio for overall survival with EPP versus no EPP was 1.9 (P=0.082).
  • The review reports median survivals for MPM of 6 to 12 months.
• The authors' conclusion: The authors concluded that prognosis remains poor for most patients. In their view, most fit patients are offered platinum-based chemotherapy that modestly improves survival, and there is considerable controversy about the true benefit of surgery and multimodality therapy.
• Limitations the authors state:
  • The authors note that there have been no definitive comparisons of the two main surgeries (EPP and pleurectomy/decortication), or of these surgeries against nonsurgical treatment.
  • The authors note that patient selection is likely influencing the survival results reported in single-arm multimodality trials.
  • The authors note that there are no large prospective studies comparing methods of obtaining a diagnostic specimen.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Chemotherapy, Bevacizumab, checkpoint inhibitors, Multimodal Therapy.

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