Newest therapeutic strategies impacting on rarest thoracic malignancies: The clinical case report of biphasic pleural mesothelioma

Our plain-English summary of Newest therapeutic strategies impacting on rarest thoracic malignancies: The clinical case report of biphasic pleural mesothelioma, by F. Pellicioli, L. Sala, F. Colonese, et al (Heliyon, 2024).

The study

• Authors: F. Pellicioli, L. Sala, F. Colonese, E. Belloni, M.I. Abbate, S. Canova, A. D'Agostino, D.L. Cortinovis
• Journal: Heliyon
• Published: 2024;10(16):e36306
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A caucasian 62-year-old woman, diagnosed with biphasic pleural mesothelioma (PM) of II stage and BAP1 loss, was treated with therapies included in clinical trial and Early Access Programmes (EAP). During her clinical history, radiological images presented an unusual representation of the disease, with a pseudo progression discussed many times by several specialists. The patient's overall survival improved as a result of the multidisciplinary team and the availability of medicines outside of clinical practice.

© 2024 The Authors.

In plain English

This was a case report by doctors based in Monza, Italy, about one woman. She was 62, Caucasian and a former smoker, and had stage II biphasic pleural mesothelioma whose tumor had lost the BAP1 protein. The article did not report whether she had been exposed to asbestos. From April 2021 she received cisplatin and pemetrexed with pegargiminase or placebo in a clinical trial. The cancer partly responded, then grew in abdominal lymph nodes. Next she received nivolumab plus ipilimumab through an early access program. Her chest disease disappeared on scans, but a lymph node near the stomach was hard to interpret. Immunotherapy stopped after 4 cycles because of side effects, including grade 3 hypoadrenocorticism. At 11 months of follow-up, a biopsy confirmed mesothelioma in a lymph node near the stomach. Later treatments were gemcitabine with ramucirumab, stopped for intestinal obstruction, and then vinorelbine. She died one month after starting home palliative care. The authors reported she lived 36 months from diagnosis, which they called more than three times the expected survival. They credited trial and early-access drugs and multidisciplinary team discussion.

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: Case report (one patient)
• Who was studied: One Caucasian 62-year-old woman, a former smoker, with stage II (cT1-2 N1M0) biphasic pleural mesothelioma with BAP1 loss and pleural effusion. She was reported by clinicians at the IRCCS San Gerardo dei Tintori Foundation, Monza, Italy, and started treatment in April 2021.
• Exposure: The article does not report any asbestos exposure for this patient. It describes her cancer treatments: chemotherapy with pegargiminase or placebo in a trial, nivolumab plus ipilimumab, gemcitabine plus ramucirumab, and vinorelbine.
• Main results:
  • First-line treatment in a phase 2/3 clinical trial was cisplatin and pemetrexed with pegargiminase (ADI PEG) or placebo. Cisplatin was switched to carboplatin. A partial response was seen at the end of chemotherapy.
  • During maintenance, the disease progressed in para-aortic lymph nodes and in nodes between the lesser curvature of the stomach and the celiac trunk.
  • After two cycles of second-line nivolumab plus ipilimumab (early access program), thoracic disease showed complete response. A lymph node near the cardias showed increased metabolic activity.
  • Side effects of immunotherapy included grade 2 hypothyroidism, grade 1 fatigue, grade 1 myalgia and grade 3 hypoadrenocorticism. Immunotherapy was stopped after 4 cycles.
  • At the PET scan after 11 months of follow-up, a lymph node between the celiac trunk and the lesser curvature of the stomach had grown. A biopsy confirmed mesothelioma.
  • Third-line gemcitabine plus ramucirumab (early access program) was suspended after 6 cycles because of intestinal obstruction requiring hospitalization.
  • Fourth-line vinorelbine was given for 3 cycles and interrupted for poor general condition. The patient died one month after starting home palliative care.
  • Looking back, the authors judged that the lymph node near the cardias had always been disease that did not respond to any treatment. They raised possible pseudo-progression related to immunotherapy.
• The authors' conclusion: The authors concluded that the patient lived 36 months from diagnosis, which they called more than three times the expected survival. They credited trial and early-access therapies and multidisciplinary team discussion. They called for equal access to therapies, including those outside clinical practice.
• Limitations the authors state:
  • Recurrence was diagnosed on a cytology sample, which the authors called limited. Only the epithelioid component was seen, and the distribution of the two tumor components could not be defined.
  • PD-L1 expression was not available for this patient.
  • An earlier endoscopic biopsy of the lymph node did not give enough material for a diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Pleural Mesothelioma, BAP1, Clinical Trial, Overall Survival, Multidisciplinary Team.

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