Need for randomized clinical trials testing targeted therapies in malignant pleural mesothelioma

Our plain-English summary of Need for randomized clinical trials testing targeted therapies in malignant pleural mesothelioma, by N. Sobhani, G. Roviello, S.P. Corona, et al (Lung Cancer, 2017).

The study

• Authors: N. Sobhani, G. Roviello, S.P. Corona, A. Ianza, F. Zanconati, D. Generali
• Journal: Lung Cancer
• Published: 2017;114:103-105
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor of Lung Cancer, written in response to an earlier article on BAP1 as a treatment target. In it, the authors reported a small meta-analysis, which pools the results of published trials, of targeted drug therapies for malignant pleural mesothelioma. The letter did not study asbestos exposure. From 253 articles found in their search, the authors included 3 randomized trials. Together these covered 1330 patients, who received either a control treatment or one of three experimental drugs: bevacizumab added to pemetrexed and cisplatin, thalidomide after first-line chemotherapy, or vorinostat. For overall survival, the pooled hazard ratio was 0.95 (95% CI 0.76-1.19; P=0.68). The authors described this as an improvement but stated that it lacked statistical significance. For progression-free survival, the pooled hazard ratio was 0.75 (95% CI 0.60-0.94; P = 0.01), which was statistically significant, with high heterogeneity among the trials (I2 of 72%). The authors concluded that more randomized trials of targeted therapies are needed, both alone and in combination. They noted that mesothelioma trials enroll small numbers of patients.

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: Letter to the editor reporting a meta-analysis (pooled analysis) of published randomized controlled trials
• Who was studied: 3 randomized phase III trials (MAPS, NVALT-5, VANTAGE-014) with a total of 1330 patients with advanced malignant pleural mesothelioma, selected from 253 articles found in a literature search
• Exposure: Targeted drug therapies, not asbestos: bevacizumab with pemetrexed and cisplatin (versus pemetrexed and cisplatin), thalidomide maintenance (versus supportive care), and vorinostat (versus placebo)
• Main results:
  • Search: 253 potentially relevant articles; 172 excluded as duplicates; 3 trials finally included
  • Overall survival, all three trials pooled, targeted therapy versus control: HR=0.95, 95% CI 0.76-1.19, P=0.68. The authors wrote that targeted therapies 'improved' overall survival but stated that the result lacked statistical significance
  • The authors stated that the overall survival result was not statistically significant
  • Progression-free survival, all three trials pooled, targeted therapy versus control: HR = 0.75, 95% CI 0.60-0.94, P = 0.01, statistically significant
  • There was high heterogeneity among the trials for progression-free survival (I2 = 72%)
  • By individual trial, the authors stated that 2 of the 3 therapies, bevacizumab and vorinostat, showed a statistical improvement in progression-free survival
• The authors' conclusion: The authors concluded that more randomized controlled trials are needed to test targeted therapies in malignant pleural mesothelioma, both as single therapies and in combination with other targeted and/or systemic drugs
• Limitations the authors state:
  • Only three randomized trials met the search criteria
  • Mesothelioma clinical trials enroll small numbers of patients; the authors stated that larger randomized cohorts would increase the reliability of findings

Topics

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

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

Related studies

• Estimating treatment effects from a randomized clinical trial in the presence of a secondary treatment — M. Zhang, Y. Wang (2012)
• The need for randomized trials in mesothelioma: let's walk the talk — T. Treasure, S. Senan (2011)
• Beta-carotene supplementation and cancer risk: a systematic review and metaanalysis of randomized controlled trials — N. Druesne-Pecollo, P. Latino-Martel, et al. (2010)
• Surgery for malignant pleural mesothelioma: why we need controlled trials — T. Treasure, M. Dusmet, et al. (2014)
• Clinical Evaluation of ErbB-Targeted CAR T-Cells, Following Intracavity Delivery in Patients with ErbB-Expressing Solid Tumors — S. Papa, M. van Schalkwyk, et al. (2015)
• Targeted therapies in malignant pleural mesothelioma: a review of clinical studies — L. Greillier, S. Marco, et al. (2011)

Browse more research in Lung Cancer, or return to medical research.