Peritoneal mesothelioma: natural history and response to chemotherapy

Our plain-English summary of Peritoneal mesothelioma: natural history and response to chemotherapy, by K.H. Antman, E.A. Pomfret, J. Aisner, et al (Journal of Clinical Oncology, 1983).

The study

• Authors: K.H. Antman, E.A. Pomfret, J. Aisner, J. MacIntyre, R.T. Osteen, J.S. Greenberger
• Journal: Journal of Clinical Oncology
• Published: 1983;1(6):386-91
• Cited by: 71 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Twenty-three patients with malignant peritoneal mesothelioma seen at the Dana Farber Cancer Institute and the University of Maryland Cancer Center from 1968 to 1982 were studied to assess the natural history of the disease and the efficacy of current treatment. Asbestos exposure was reported by 57%. Of 18 patients receiving a doxorubicin-containing regimen, 14 had measurable or evaluable disease. One complete response, four partial responses and one regression (in a patient with evaluable but not measurable disease) were observed, ranging in duration from 6 to 36 months. A single patient remains disease free for more than 36 months after subsequent radiotherapy. Significant clotting abnormalities (including disseminated intravascular coagulation, massive thrombosis, fatal pulmonary emboli, Coombs-positive hemolytic anemia, and phlebitis) occurred in 22% of the patients. Trends toward decreased survival were observed for smokers, patients presenting with ascites, and those with stage II-IV disease.

In plain English

This study reported on 23 patients (15 men and 8 women, aged 24 to 78) with malignant peritoneal mesothelioma treated at the Dana Farber Cancer Institute and the University of Maryland Cancer Center between 1968 and July 1982. Some patients' charts were reviewed after the fact. Patients seen at Dana Farber since July 1979 were followed on a prospective protocol. Twelve of the 23 reported asbestos exposure, lasting from 2 months to 38 years. The article did not name fiber types. All 18 patients who received chemotherapy were first given a doxorubicin-containing regimen. Of the 14 with measurable or evaluable disease, 6 (43%) responded: one complete response, four partial responses and one regression. Median survival was 22 months for the 6 responders and 5 months for 8 patients whose disease was stable or progressed. Clotting abnormalities affected five patients (22%). Smokers and patients presenting with ascites showed a trend toward shorter survival, but none of the differences was statistically significant. The authors concluded that peritoneal mesothelioma had proven relatively responsive to chemotherapy. They noted the number of patients was too small for statistical significance.

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 series of treated patients; some charts abstracted retrospectively, with later Dana Farber patients followed on a prospective protocol
• Who was studied: 23 patients (15 men, 8 women) with histologically confirmed malignant peritoneal mesothelioma: 19 treated at the Dana Farber Cancer Institute (Boston) and 4 at the University of Maryland Cancer Center (Baltimore), 1968 to July 1982; ages 24 to 78 (median 52)
• Exposure: Self-reported asbestos exposure in 12 of 23 patients, lasting from 2 months to 38 years. Of the 12, 8 worked with or near asbestos for 30 years or more. Fiber types are not named. 43% of patients were known cigarette smokers. The treatment studied was doxorubicin-containing chemotherapy.
• Main results:
  • Among the 14 previously untreated patients with measurable or evaluable disease given doxorubicin-containing regimens, 6 (43%) responded: 1 complete response, 4 partial responses, 1 regression
  • Median survival was 22 months for the 6 responding patients versus 5 months for the 8 patients with stable or progressive measurable or evaluable disease
  • Doxorubicin dose: 4 of 9 patients (44%) receiving at least 20 mg/m2/wk responded, compared with 2 of 9 (22%) receiving less
  • No previously treated patient responded to a second chemotherapy regimen
  • Clotting abnormalities occurred in 5 of the 23 patients (22%): disseminated intravascular coagulation, thrombosis with pulmonary emboli, and Coombs-positive hemolytic anemia with phlebitis
  • Trends toward shorter survival were seen in smokers and in patients presenting with ascites, and stage I patients survived longer than stage III or IV patients, but none of these differences was statistically significant
  • Of the 18 patients who had died, 10 died directly from localized disease, inanition or small bowel obstruction (the article prints this as 61%)
• The authors' conclusion: The authors concluded that peritoneal mesothelioma had proven relatively responsive to chemotherapy, with occasional long-lasting responses to doxorubicin-containing regimens, and that further studies of such regimens seemed warranted.
• Limitations the authors state:
  • The number of patients was too small to provide statistical significance
  • Initial surgery was mostly done in community hospitals, so no uniform criteria for surgical resection were applied
  • Doses were intertwined: higher cyclophosphamide doses were generally given with lower doxorubicin doses

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Chemotherapy, Asbestos Exposure, Doxorubicin, Ascites.

Related studies

• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Cytoreductive surgery with selective versus complete parietal peritonectomy followed by hyperthermic intraperitoneal chemotherapy in patients with diffuse malignant peritoneal mesothelioma: a controlled study — D. Baratti, S. Kusamura, et al. (2012)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)

Browse more research in Journal of Clinical Oncology, or return to medical research.