Pleural mesothelioma

Our plain-English summary of Pleural mesothelioma, by P. Ruffie (Current Opinion in Oncology, 1992).

The study

• Author: P. Ruffie
• Journal: Current Opinion in Oncology
• Published: 1992;4(2):334-41
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse pleural malignant mesothelioma (DMM) is an uncommon tumor in the general population, but its incidence can be very high in persons exposed to asbestos. There has been controversy about the role of the different fiber types and their responsibility for causing DMM, particularly with chrysotile. Distinguishing between DMM and peripheral adenocarcinoma with pleural involvement is a frequent diagnostic problem. Immunohistochemical markers (positive for vimentin and negative for carcinoembryonic antigen and Leu M1) and electronmicroscopy aid in the diagnosis. Therapeutic results remain poor, and cure of DMM is rare. Local treatments such as surgery or radiation therapy are technically difficult because of the extent of disease. DMM continues to be a chemoresistant tumor. Because DMM is rare, study of this tumor has been hampered by the limited number of available patients in any given institution. Therefore, animal models or representative human malignant mesothelioma cell lines are needed for a dual investigation: first of the basic biology of this disease and second for a preclinical evaluation of chemotherapeutic agents and recombinant anticancer cytokines alone or in combination. Ongoing trials confirm that DMM is resistant to standard forms of therapy, but mesothelial cells are susceptible to immune effector cells and cytokines in in vitro and in vivo models. Thus, recombinant interferon-alpha, -beta, and -gamma have been used for both local and systemic treatment, as has interleukin-2 with and without autologous lymphokine-activated killer cells. In addition, substantial experimental evidence suggests synergy between cytotoxic drugs and cytokines.

In plain English

This article was a narrative review of recently published research on diffuse pleural malignant mesothelioma. The author did not report a new study. It described a case-control study of lung tissue from 221 patients and 359 controls, in which the greatest risk was associated with exposure to long crocidolite fibers. In that study, a small group with only chrysotile in the lungs also showed a statistically significant trend of risk with lung fiber content. Citing a review by Gibbs, the author reported that crocidolite carries the greatest risk, amosite an intermediate risk and chrysotile the least. The author noted that the risk from chrysotile alone is difficult to assess because exposure is almost always mixed with amphiboles. The review also covered diagnosis and treatment. Median survival from diagnosis was less than 1 year, and treatment results remained poor. The author concluded that the tumor should still be considered chemoresistant. The author judged, from what the author called a pessimistic point of view, that available data did not justify routine chemotherapy, and called for further research, including human mesothelioma cell lines.

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 published literature (annual review in Current Opinion in Oncology); no new data collected by the author
• Who was studied: No study population of its own; the article reviewed published studies on diffuse pleural malignant mesothelioma (DMM), mostly from about 1990 to 1991, covering causes, pathology, diagnosis, imaging and treatment
• Exposure: Asbestos fiber types (chrysotile, crocidolite, amosite, tremolite-actinolite, anthophyllite) and the non-asbestos fiber erionite (a fibrous zeolite), as discussed in the reviewed literature
• Main results:
  • The review cited a case-control study (Leigh's Australian group) of lung tissue in 221 patients and 359 controls, which found that the greatest risk of DMM was associated with exposure to long crocidolite fibers (10 μm or longer)
  • In the same cited study, analysis of a small group of cases and controls with only chrysotile in the lungs also showed a statistically significant trend of relative risk of DMM with lung fiber content
  • According to Gibbs' review, as reported by the author, crocidolite carries the greatest risk, chrysotile the least, and amosite an intermediate risk. Tremolite probably has a risk comparable to crocidolite, and Turkish erionite carries a high risk
  • The review cited a hospital-based case-control study of 124 DMM cases that found no interaction between cigarette smoking and asbestos exposure in the risk of DMM
  • The review reported that, according to three cited studies, reactivity for at least two of three markers (carcinoembryonic antigen, Leu-M1 and B72.3) appears to exclude a diagnosis of pleural mesothelioma
  • The review reported that median survival from diagnosis is less than 1 year and that 5-year survival is estimated at less than 5%
  • The review reported that treatment results remain poor, and that retrospective studies show no drastic survival differences between groups given different treatments
  • Doxorubicin had been considered the most active drug, with an estimated response above 40%. A large prospective trial cited in the review did not confirm this and found an overall response of only 10%
  • In a cited study of intrapleural recombinant interferon-γ, there were four complete and one partial response among nine stage I patients, but only one partial response among 10 stage II patients
• The authors' conclusion: The author concluded that DMM should still be considered a chemoresistant tumor. The author stated that, from a pessimistic point of view, the available data do not justify routine use of chemotherapy, and that further investigation is required. The author also stated that phase II trials may identify more active drugs. The author called for human malignant mesothelioma cell lines to be established to study the disease's biology and to test chemotherapy drugs and cytokines
• Limitations the authors state:
  • The author stated that the debate over the role of different fiber types persists for several reasons: few populations or occupational cohorts were exposed to only one fiber type, the latent period is long (about 35 years), pathologic diagnosis is difficult, and data on workers' airborne fiber levels are lacking
  • The author stated that the risk from chrysotile alone is difficult to assess, because exposure to amphibole and chrysotile is almost always mixed and because fibers may clear from the lungs at different rates
  • The author stated that because the tumor is uncommon, chemotherapy studies have too few patients to permit analysis, and that anecdotal reports and unreported negative results may lead to overestimates of drug activity

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, Malignant Mesothelioma, Chrysotile, Adenocarcinoma, Carcinoembryonic Antigen (CEA), Cytokine, Mesothelial Cells.

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Browse more research in Current Opinion in Oncology, or return to medical research.