NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016

Our plain-English summary of NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016, by D.S. Ettinger, D.E. Wood, W. Akerley, et al (Journal of the National Comprehensive Cancer Network, 2016).

The study

• Authors: D.S. Ettinger, D.E. Wood, W. Akerley, L.A. Bazhenova, H. Borghaei, D.R. Camidge, R.T. Cheney, L.R. Chirieac, T.A. D'Amico, T. Dilling, M. Dobelbower, R. Govindan, M. Hennon, L. Horn, T.M. Jahan, R. Komaki, R.P. Lackner, M. Lanuti, R. Lilenbaum, J. Lin, B.W. Loo, R. Martins, G.A. Otterson, J.D. Patel, K.M. Pisters, K. Reckamp, G.J. Riely, S.E. Schild, T.A. Shapiro, N. Sharma, S.J. Swanson, J. Stevenson, K. Tauer, S.C. Yang, K. Gregory, M. Hughes
• Journal: Journal of the National Comprehensive Cancer Network
• Published: 2016;14(7):825-36
• Cited by: 79 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Malignant Pleural Mesothelioma (MPM). These NCCN Guidelines Insights discuss systemic therapy regimens and surgical controversies for MPM. The NCCN panel recommends cisplatin/pemetrexed (category 1) for patients with MPM. The NCCN panel also now recommends bevacizumab/cisplatin/pemetrexed as a first-line therapy option for patients with unresectable MPM who are candidates for bevacizumab. The complete version of the NCCN Guidelines for MPM, available at NCCN.org, addresses all aspects of management for MPM including diagnosis, evaluation, staging, treatment, surveillance, and therapy for recurrence and metastasis; NCCN Guidelines are intended to assist with clinical decision-making.

Copyright © 2016 by the National Comprehensive Cancer Network.

In plain English

This article is not a new study but a clinical practice guideline update from the National Comprehensive Cancer Network (NCCN). It sets out its expert panel's consensus and highlights recent changes to the NCCN guidelines for treating malignant pleural mesothelioma (MPM). It did not study asbestos; its overview notes MPM occurs mainly in older men exposed to asbestos. The panel recommended cisplatin/pemetrexed chemotherapy as category 1. It cited an earlier phase III trial in which median survival was 12.1 months with the combination versus 9.3 months with cisplatin alone. The panel added bevacizumab/cisplatin/pemetrexed as a first-line option only for patients with unresectable disease who are candidates to receive bevacizumab. A separate cited phase III trial reported median overall survival of 18.8 months (95% CI 15.9 to 22.6) with the three-drug regimen versus 16.1 months (95% CI 14.0 to 17.9) with cisplatin/pemetrexed, and grade 3 or higher high blood pressure in 23% versus 0%. The panel considered pleurectomy/decortication and extrapleural pneumonectomy both reasonable surgical options in select patients, but said it is unclear which is better for cancer outcomes. The authors called the choice of surgery controversial.

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: Clinical practice guideline update (NCCN Guidelines Insights), a consensus statement by an expert panel summarizing changes to the guidelines and the literature reviewed; not an original study
• Who was studied: No new patients were studied; the guideline addresses the management of patients with malignant pleural mesothelioma
• Exposure: Asbestos exposure was not studied. The overview, citing other work, notes that MPM occurs mainly in older men who have been exposed to asbestos. The article is about treatments: chemotherapy regimens (cisplatin/pemetrexed, carboplatin/pemetrexed, cisplatin/gemcitabine, bevacizumab/cisplatin/pemetrexed), surgery and radiation therapy.
• Main results:
  • The panel recommended cisplatin/pemetrexed as a category 1 first-line combination regimen
  • In a cited phase III trial (not this article's own data), cisplatin/pemetrexed gave median survival of 12.1 months compared with 9.3 months for cisplatin alone, in patients who were not candidates for surgery
  • The panel added bevacizumab/cisplatin/pemetrexed as a first-line option only for patients with unresectable MPM who are candidates for bevacizumab
  • In a cited phase III randomized trial (not this article's own data), median overall survival in the bevacizumab triplet arm was 18.8 months (95% CI, 15.9 to 22.6)
  • In the same cited trial, median overall survival in the cisplatin/pemetrexed arm was 16.1 months (95% CI, 14.0 to 17.9); hazard ratio 0.77 (95% CI, 0.62 to 0.95)
  • In the same cited trial, grade 3 or higher hypertension was more frequent in patients receiving the bevacizumab triplet (23% vs 0%)
  • The panel considered extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) each reasonable surgical options in select patients
  • The panel stated it is unclear which operation, P/D or EPP, gives better cancer outcomes
• The authors' conclusion: The authors concluded that cisplatin/pemetrexed remains the category 1 recommendation, and the NCCN panel now also recommends bevacizumab/cisplatin/pemetrexed as a first-line option for patients with unresectable MPM who are candidates for bevacizumab
• Limitations the authors state:
  • The authors state the choice of surgery for MPM is controversial because randomized controlled trial data are not available
  • The authors state these Insights do not represent the full NCCN Guidelines

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, Systemic Therapy, Cisplatin, Pemetrexed (Alimta), Bevacizumab, First-line Therapy, Unresectable, Staging.

Related studies

• Malignant pleural mesothelioma — D.S. Ettinger, W. Akerley, et al. (2012)
• Revised Modified Response Evaluation Criteria in Solid Tumors for Assessment of Response in Malignant Pleural Mesothelioma (Version 1.1) — S.G. Armato, A.K. Nowak (2018)
• Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire — Ó. Arrieta, C. Núñez-Valencia, et al. (2012)
• Revised Modified RECIST Criteria in Malignant Pleural Mesothelioma (Version 1.1): A Step Forward in a Long Race — A.S. Tsao, G.W. Gladish, et al. (2018)
• 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)

Browse more research in Journal of the National Comprehensive Cancer Network, or return to medical research.