Multimodal treatment for malignant pleural mesothelioma

Our plain-English summary of Multimodal treatment for malignant pleural mesothelioma, by R.C. Rintoul, T. Treasure, F. Macbeth (The Lancet. Oncology, 2015).

The study

• Authors: R.C. Rintoul, T. Treasure, F. Macbeth
• Journal: The Lancet. Oncology
• Published: 2015;16(16):1576-7
• Type of article: Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article is a short commentary, not an original study. The authors discussed a separate trial, SAKK 17/04, reported by Stahel and colleagues. In that trial, people with malignant pleural mesothelioma received chemotherapy followed by extrapleural pneumonectomy, and 54 of them were then randomly assigned to hemithoracic radiotherapy or no radiotherapy. As the commentary describes it, median overall survival in that trial was 19.3 months (95% CI 11.5 to 21.8) with radiotherapy and 20.8 months (14.4 to 27.8) without it. The trial did not enrol enough patients to show the difference its investigators had planned to detect. Of the 151 patients who entered the trial, 97 (64%) did not complete treatment as intended, and overall survival for all 151 was 15.0 months (95% CI 12.1 to 19.3). The commentators agreed with the trial authors that treatment concepts for this disease need revising. They disputed the trial authors' view that extrapleural pneumonectomy should still be considered for selected low-risk patients. The authors concluded that more randomised trials are needed.

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: Commentary (editorial comment) on a separately published randomised phase 2 trial (SAKK 17/04) by other investigators; not an original study
• Who was studied: Patients with malignant pleural mesothelioma in the SAKK 17/04 trial, as described by the commentators: 151 patients entered the trial, 113 had extrapleural pneumonectomy after chemotherapy, 74 of these were eligible for radiotherapy (20 declined), and 54 were randomised
• Exposure: Treatment, not asbestos exposure: neoadjuvant chemotherapy and extrapleural pneumonectomy, followed by hemithoracic radiotherapy or no radiotherapy
• Main results:
  • In the SAKK 17/04 trial (as reported in the commentary), median overall survival was 19.3 months (95% CI 11.5 to 21.8) in the radiotherapy group and 20.8 months (14.4 to 27.8) in the no-radiotherapy group
  • Overall survival for all 151 patients who entered the SAKK 17/04 trial was 15.0 months (95% CI 12.1 to 19.3)
  • 97 (64%) of the 151 patients in the SAKK 17/04 trial did not complete treatment as intended
  • The commentators said the longer survival of the 54 randomised patients cannot be attributed to treatment, because being randomised required continued survival with WHO performance status 0 to 2
• The authors' conclusion: The authors agreed with the trial investigators that treatment concepts for malignant pleural mesothelioma need revising. They said the trial authors lacked evidence for continuing to consider extrapleural pneumonectomy in selected patients, and they called for more randomised trials.
• Limitations the authors state:
  • The commentators noted that the SAKK 17/04 trial could not enrol enough patients to show the difference its investigators considered meaningful. This is a limitation of the trial discussed, not of the commentary itself.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? — A. Rimner, C.B. Simone, et al. (2016)
• Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? - Authors' reply — O. Riesterer, W. Weder, et al. (2016)
• Fifteen years in the evaluation of extrapleural pneumonectomy: Lessons to be learned — T. Treasure, F. Macbeth (2015)
• Updated patterns of failure after multimodality therapy for malignant pleural mesothelioma — E.H. Baldini, W.G. Richards, et al. (2015)
• Importance of excision repair cross-complementation group 1 and ribonucleotide reductase M1 as prognostic biomarkers in malignant pleural mesothelioma treated with platinum-based induction chemotherapy followed by surgery — L. Frischknecht, M. Meerang, et al. (2015)
• The mesothelioma enigma — R.M. Flores (2015)

Browse more research in The Lancet. Oncology, or return to medical research.