Novel intrapleural therapies for malignant diseases

Our plain-English summary of Novel intrapleural therapies for malignant diseases, by A.R. Haas, D.H. Sterman (Respiration; International Review of Thoracic Diseases, 2012).

The study

• Authors: A.R. Haas, D.H. Sterman
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2012;83(4):277-92
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural malignancies, either primary or metastatic, are common and problematic clinical issues in thoracic oncology and pulmonary medicine. Malignant pleural mesothelioma and metastatic pleural effusions often present late in the course of a disease and have a dramatic impact on the patient's quality of life and survival. Novel approaches to manage mesothelioma and malignant pleural effusions are desperately needed and the pleural space provides a unique platform as an easily accessible body cavity for developing and assessing these treatments and their responses. In this review, we discuss the unique intrapleural chemotherapeutic, immunotherapeutic and genetic treatments that have been investigated, as well as those under current clinical development. While responses have been demonstrated to variable degrees with all these approaches, an integrated multimodality approach incorporating these methods with other anti-neoplastic interventions ultimately will ensure the best responses and patient outcomes.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This article was a narrative review, not an original study. The authors described treatments delivered into the pleural space (a body cavity in the chest, lined by a thin layer of cells) for malignant pleural mesothelioma and for fluid build-up from cancers that had spread to the pleura. They grouped earlier work into intrapleural chemotherapy, immunotherapy and gene therapy. Among the studies described, a trial of intrapleural interferon by Boutin and colleagues reported complete responses in 4 of 9 patients with stage IA mesothelioma, all of whom had pleural nodules under 5 mm across. A later 89-patient trial reported a 20% overall response rate, and 45% in stage I disease. In one gene therapy trial, gene transfer was confirmed in 11 of 20 evaluable patients. In another, 4 of 10 patients showed disease stability or regression at day 60. The authors noted that many immunotherapy studies lacked randomization and proper controls. The authors concluded that intrapleural chemotherapy alone was of minimal benefit but might help with maximal tumor debulking and hyperthermia. The article did not study asbestos exposure.

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 intrapleural chemotherapy, immunotherapy and gene therapy for pleural malignancies
• Who was studied: No study population of its own. The review covers published studies of patients with malignant pleural mesothelioma and with metastatic pleural effusions from other cancers, along with some animal studies.
• Exposure: Not asbestos exposure. The 'exposures' reviewed are treatments delivered into the pleural space: chemotherapy, immunotherapy and gene therapy.
• Main results:
  • Reported from a cited phase I/II trial (Boutin et al.) of intrapleural interferon in 22 patients with mesothelioma: complete responses in 4 of 9 patients with stage IA disease.
  • In that same trial, all of the patients with complete responses had pleural nodules less than 5 mm in diameter.
  • Reported from a cited multi-institutional phase II trial of intrapleural interferon in 89 mesothelioma patients: overall response rate 20%, and 45% in patients with stage I disease.
  • Reported from a cited phase I trial (Sterman et al.) of an adenoviral HSVtk vector given into the pleural space of 21 mesothelioma patients: gene transfer was confirmed in 11 of 20 evaluable patients.
  • Reported from a cited 2007 single-dose interferon gene transfer trial in 10 patients (7 with pleural mesothelioma, 3 with malignant pleural effusion): 4 of 10 showed disease stability or regression at day 60.
  • Reported from a cited trial of Ad.IFN-alpha2b in 9 pleural mesothelioma patients: at 60 days, 3 had progressive disease, 4 had stable disease and 2 had partial responses.
  • Reported from a cited phase I trial (Schwarzenberger et al.) of gene-modified PA1STK cells in 15 mesothelioma patients: no objective radiographic responses.
• The authors' conclusion: The authors concluded that intrapleural chemotherapy on its own was of minimal benefit in pleural malignancies but might be beneficial when combined with maximal tumor debulking and with hyperthermia.
• Limitations the authors state:
  • The authors stated that many of the immunotherapy studies they reviewed lacked randomization and appropriate control groups.
  • The authors stated that the two p53 gene therapy trials they reviewed lacked data on tumor response rates or survival.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Effusion, Quality of Life, Mesothelioma.

Related studies

• Malignant pleural mesothelioma: update on treatment options with a focus on novel therapies — A.R. Haas, D.H. Sterman (2013)
• The efficacy of pemetrexed and bevacizumab intrapleural injection for malignant pleural mesothelioma-mediated malignant pleural effusion — D. Chen, X. Li, et al. (2014)
• Closing faucets: the role of anti-angiogenic therapies in malignant pleural diseases — D. Marquez-Medina, S. Popat (2016)
• Biological basis for novel mesothelioma therapies — J. Obacz, H. Yung, et al. (2021)
• Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial — V.W. Rusch, R. Figlin, et al. (1991)
• Chemotherapy and targeted therapies for unresectable malignant mesothelioma — R.J. Kelly, E. Sharon, et al. (2011)

Browse more research in Respiration; International Review of Thoracic Diseases, or return to medical research.